HHSC Reminder that Claims Must Include NPI of Enrolled Ordering or Referring Professional

HHSC has released the following bulletin regarding claims for ordering and referring physicians and other professionals:

"Reminder: It is the responsibility of the billing provider to ensure that submitted claims contain the National Provider Identifier number of the physician or other professional who ordered, referred or prescribed the items or services. Additionally, all ordering, referring or prescribing providers must be enrolled as participating providers in Texas Medicaid as required. Be advised that claims will be denied if the NPI is missing or invalid and if the provider is not appropriately enrolled.

These requirements impact the Medicaid, Healthy Texas Women, and Children with Special Health Care Needs Services programs only. However, these requirements do not apply to out-of-network providers that order, refer or prescribe only for managed care members.

Providers can also refer to the article titled "Implementation for Required Enrollment of All Ordering, Referring or Prescribing Providers as of January 15, 2018," that was published on the TMHP website on November 3, 2017, for more information about ordering, referring or prescribing provider information.

For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-925-9126."