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ALERT: Stay healthy this cold and flu season! Learn more

ALERTA: ¡Mantente sano durante esta temporada de influenza y resfriados! Más información

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ALERT: We have made the Texas Children’s Health Plan website even easier to use! Click here to learn more.

ALERTA: ¡Ahora el sitio web de Texas Children’s Health Plan es aún más sencillo de usar! Haz clic aquí para más información.

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ALERT: Shortage of Enfamil products until October 31, 2024. Learn more.

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Inactive National Provider Identifiers in National Plan and Provider Enumeration System to Trigger Disenrollment Action

Date: May 10, 2023

Attention: All Providers

Effective date: April 27, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware that 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).

Provider Requirements, verification and next steps:

  • Providers must have an active NPI to remain active in any Texas state healthcare 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.

Provider Resources:

Texas Medicaid Provider Procedures Manual, Section 1, “Provider Enrollment and Responsibilities

Provider Enrollment | TMHP

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.