May 19, 2023
Reminder
Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid reminds you to ensure your National Provider Identifiers (NPIs) listed are active and correct with the National Plan and Provider Enumeration System (NPPES) to avoid disenrollment from Texas State Medicaid, resulting in a payment denial code (PDC) 64 add to your record in the Master Provider File (MPF).
Action
- You must have an active NPI to remain active in any Texas state healthcare program. You should contact NPPES at 1-800-465-3203 to research and resolve any issue with your NPI status immediately.
- Texas Medicaid and Healthcare Partnership (TMHP) will reverify your NPI status with NPPES when the next NPPES dissemination file is released. Once the NPI is reinstated the payment hold will have an end date.
- Any claims and prior authorization requests that are submitted for dates of service on or after the disenrollment will be denied.
Resources
Providers can refer to:
- Current Texas Medicaid Provider Procedures Manual, Section 1, “Provider Enrollment and Responsibilities”
- Provider Enrollment - TMHP
Questions
Providers, for questions or additional information, please:
- Contact your Medicaid Provider Network Representative at 1-855-212-1615
- Submit via email Texas Medicaid Network Department