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Texas Medicaid Provider Enrollment Application Rev. XXIX F00106 Introduction Dear Health-care Professional Thank you for your interest in becoming a Texas Medicaid provider. The TVFC application is attached at the end of this Texas Medicaid A. 1 - A. 3 Provider of Services This section is for provider demographic information. Provide complete and correct information as required. A. Tmhp.com. Select Reference Materials from the Providers page. There is no guarantee your application will be...
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We are also required to submit one copy to the office of CMS and a second copy to the Texas Department of Family and Protective Services (DIPS). Applications and supporting documentation must be uploaded to this web page within the next thirty (30) days after an application is submitted. If selected to participate, you must register your provider account with MHP by January 31, 2003, and notify MHP that your claim (the number of Patients and services covered per claim) has been sent to CMS. All requests to change provider locations during this period must be submitted in writing by. October 30, 2002, and forwarded to MHP in writing by January 31, 2003. This section contains the following information: What to do when filling out this application. What to expect when submitting your application. Form I-5, Texas Medicaid Application, form with form #S15-10-1. Form CPT-1, provider verification form, form with form #D13-17-11. Note: We have a separate page for providers who must be licensed by Texas Health and Human Services Commission or Provider organizations, where they can be found by clicking the link here. This page is provided for convenience only and is subject to updates Please send any application requests to: Texas Department of Health and Human Services State Director, Insurance Claims (AIMS) Services Program C/o Michael L.