ACA Medicaid Provider Enrollment Deadline and Texas Medicaid Specifics

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Do you or your practice order or refer for Medicaid patients, even if you don't otherwise participate in Medicaid? If so, there's an important deadline coming up.

By October 1, 2017 - which is right around the corner - you must enroll in Medicaid as required by the Affordable Care Act (ACA). Anyone who orders or refers for Medicaid patients in your practice must enroll including physicians, advanced practice registered nurses, physician assistants and other health care professionals and providers.

If you already have enrolled as an ordering and referring-only practice, or if you already have a Medicaid provider number, you are all set.

Enrollment also applies to those physicians who only care for dual-eligible patients (those who are eligible for both Medicare and Medicaid) and who order Medicaid-only services for those patients. These physicians must enroll as an ordering and referring physician.

Here are a few more important points:

  • After October 1, Medicaid patients won't be able to fill a prescription if the ordering and referring physician or other provider is not enrolled. In addition to prescriptions, the following services also require an order or referral: clinical, radiological or laboratory services; home health agency services; durable medical equipment; eyeglasses; hearing aids.

  • You must include the National Provider Identifier (NPI) of the ordering, prescribing or referring provider on the claim when submitting a claim for services that require an order or a referral.

  • Residents and interns at your practice will be able to order and refer using the supervising physician's NPI or their own if they have one.

At 1st Assistant, credentialing is our ONLY business! Let us take the administrative burden of provider enrollment off of you and your staff so you can focus on treating your patients.

Resources for Texas Medicaid Providers

Texas Medicaid providers can find more information and enroll at the Texas Medicaid and Healthcare Partnership website.

 

There is an abbreviated enrollment application available from the Texas Medicaid and Healthcare Partnership for those physicians whose only relationship with Texas Medicaid is to order or refer services to Medicaid clients.

Let Us Manage All Your Payor Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.