Guidance: MCO LTSS Provider Enrollment
The deadline for Long-term Services and Supports (LTSS) providers serving managed care members (“MCO LTSS providers”) required to enroll through the Medicaid MCO LTSS provider enrollment process has been extended to September 1, 2018. HHSC is providing guidance on how MCOs can verify a provider’s enrollment.
An MCO LTSS Provider is any provider who provides LTSS services under a specific National Provider Identifier (NPI) and taxonomy combination through Medicaid Managed Care, but does not have an active TPI through TMHP, an API through this process, or an enrollment through DADS (Legacy).
To allow sufficient time for application processing, MCOs should encourage MCO LTSS providers to submit applications as soon as possible. The MCOs will cease claims processing effective September 1, 2018, for any MCO LTSS provider who has not successfully completed the enrollment process.
MCOs are not to use the LTC Master Provider File to determine an LTSS provider’s enrollment. These files are not efficient for this purpose. MCOs should continue to use the LTSS Master Provider File and the Master Provider File provided by TMHP. If a provider is not found on either file, the MCO should direct that provider to contact MCO_LTSS_Provider_Re-Enrollment@hhsc.state.tx.us. The provider’s request must include the provider’s business name, tax identification number, NPI and taxonomy code.
MCO LTSS Quick Tips are attached.