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Texas Medicaid Provider Enrollment Application Updated to Support New Wheeled Mobility Providers

Information posted July 15, 2011

The paper version of the Texas Medicaid Provider Enrollment Application has been updated effective June 13, 2011, and is now available. New and currently enrolled durable medical equipment (DME) providers that want to supply specialized or custom wheeled mobility systems to Texas Medicaid and Primary Care Case Management (PCCM) clients must enroll in Texas Medicaid as specialized/custom wheeled mobility group providers with at least one qualified rehabilitation professional (QRP) as a performing provider. Certified QRP providers must enroll in Texas Medicaid as performing providers under at least one DME provider group. Providers may choose one of two ways to enroll: One-page enrollment application process. Currently enrolled DME providers can use the one-page Wheeled Mobility Systems Group Enrollment Application through August 15, 2011. For more information, providers may refer to the article titled DME and QRP Provider Enrollment Forms Now Available, which was published on May 12, 2011 on this website. Complete enrollment application. New and currently enrolled DME providers can complete the full online or paper version of the Texas Medicaid Provider Enrollment Application.

Enrollment Application Process Using the Full Texas Medicaid Provider Enrollment Application

New and currently enrolled DME providers that want to supply specialized or custom wheeled mobility systems can submit a complete enrollment application as follows: 1. Complete the wheeled mobility group provider enrollment using the online application or the paper Texas Medicaid Provider Enrollment Application, which is available for download on this website. a. In the Texas Medicaid Identification Form, Traditional Services section on page 2.1 of the application, choose the check box for "Specialized/Custom Wheeled Mobility - CCP" or "Specialized/Custom Wheeled Mobility - Home Health." Note: To enroll as both a Comprehensive Care Program (CCP) and home health wheeled mobility systems group provider, applicants must complete an enrollment form for CCP and a separate enrollment form for home health. b. In the Requesting Enrollment As section on page 5.1 of the application, choose the check box for "Group." c. In Section C ­ Group Practice section on page 5.4 of the application, choose the check box for "Enrolling a new group with performing provider(s)." 2. Complete the QRP performing provider enrollment using the online application or the paper Texas Medicaid Provider Enrollment Application, which is available for download on this website. The DME provider may complete the QRP enrollment or the QRP may complete his or her enrollment. The QRP provider must enroll with

Texas Medicaid as a performing provider under at least one wheeled mobility group provider. a. In the Texas Medicaid Identification Form, Traditional Services section on page 2.1 of the application, choose the check box for "Qualified Rehabilitation Professional (QRP)." b. In the Requesting Enrollment As section on page 5.1 of the application, choose the check box for "Performing Provider."

Additional Information

For more information, providers may refer to the following articles that were published on this website: Coming Soon: Provider Enrollment for DME and QRP Providers to Prepare for Wheeled Mobility Systems Benefit Changes (article published on February 25, 2011) Update to "DME Provider Taxonomy Code Changes" (article published on February 25, 2011) DME Provider Taxonomy Code Changes (article published on February 11, 2011)

For more information, call the TMHP Contact Center at 1-800-925-9126.

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