As a requirement of the Patient Protection and Affordable Care Act (PPACA), state Medicaid agencies must revalidate the enrollment of all providers in state Medicaid programs. The original revalidation deadline was March 24, 2016, but was extended by the Centers for Medicare and Medicaid Services (CMS) to allow states additional time to process provider applications. For Texas Medicaid, this means all providers, including ordering and referring providers, who have not met all PPACA revalidation requirements must do so through re-enrollment by Sept. 24, 2016.
To avoid disenrollment on Sept. 25, 2016, and possible disruption in claims payment, providers should submit a re-enrollment application to the state or TMHP today.
Applications Received After June 17, 2016
Texas Medicaid will normally process complete applications received on or after June 17, 2016; however, Texas Medicaid cannot guarantee that those applications will be completely processed by the Sept. 24, 2016, deadline.
If final approval on an application received after June 17, 2016, is not completed by Sept. 24, 2016, the provider will be dis-enrolled from Texas Medicaid. Providers including, but not limited to, ordering and referring providers, will be dis-enrolled from Texas Medicaid with an effective date of Sept. 25, 2016, if the application is received after June 17, 2016, and a final determination on the application is pending.
Though these applications will continue to be processed, a gap in enrollment will exist between Sept. 25, 2016, and the date the application is approved. Providers whose applications are denied will remain dis-enrolled with an effective date of Sept. 25, 2016.
Providers with a gap in Medicaid enrollment will not be eligible to receive reimbursement for claims with dates of service during the time the provider is not enrolled in Texas Medicaid. If the re-enrollment application is approved at a later date, the re-enrollment date will be the date the application was approved. The effective date will not be retroactive to the date the provider was dis-enrolled. Additionally, dis-enrolled providers will not be eligible to participate in Medicaid managed care organizations (MCOs) or dental maintenance organizations (DMOs) during the dis-enrolled period.