Texas Medicaid and Healthcare Partnership (TMHP) has identified several National Provider Identifiers (NPI) as inactive in the National Plan and Provider Enumeration System (NPPES) and will be taking immediate disenrollment action, which will result in a payment denial code (PDC) 64 added on to the provider record in the Master Provider File (MPF).
- Providers must have an active NPI to remain active in any Texas state health care program. Providers should contact NPPES at 1-800-465-3203 to research and resolve any issues with the NPI status.
- TMHP will reverify the NPI status with NPPES when they release the next NPPES dissemination file, and the payment hold will be end dated once the NPI is reinstated.
- Any claims and prior authorization requests that are submitted for dates of service on or after the disenrollment date will be denied.
Providers can also refer to the current Texas Medicaid Provider Procedures Manual, General Information, Section 1, “Provider Enrollment and Responsibilities,” for more information.
Resources:
Providers may find more information on Provider Enrollment at Provider Enrollment | TMHP
Community First Resources:
Contact:
Email ProviderRelations@cfhp.com or call 210-358-6294.