Effective January 2013: Ordering- and Referring-Only Providers Must Enroll in Texas Medicaid


Texas Medicaid providers that receive referrals from non-participating physicians or other health care providers need to beaware that beginning January 1, 2013, individual providers who arenot currently enrolled in Texas Medicaid and whose only relationship with Texas Medicaid is to order or refer supplies or services for Texas Medicaid-eligible clients must enroll in Texas Medicaid as participating providers in accordance with provisions of the Affordable Care Act of 2010 (ACA).

The Code of Federal Regulations (CFR) Title 42 §455.410(b) requires all ordering or referring physicians or other professionals who order or refer supplies and services under the Medicaid State plan, or under a waiver of the plan, to enroll in Medicaid as participating providers.

Although ordering and referring providers will not submit claims to Texas Medicaid, the ordering and referring provider's National Provider Identifier (NPI) will be required on claims that are submitted by the providers that render the supplies or services.

Please see full alert below for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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