D’oh! Another Approval Delaying TMHP DMO Credentialing Snafu!

TDMR received an email from a provider that a new problem had developed in credentialing a dentist that adds even more time to the process.

No TPI in welcome letter

Apparently, TMHP is no longer including the TPI (Texas Provider Identifier) in their welcome letters introducing newly approved dentists so the DMOs have to wait until the state puts the provider’s TPI in the master provider list to get the number.


TMHP said it was moving to replace the TPI with the provider’s NPI.  That’s why they removed the TPI from the welcome letters. But the DMOs still use the TPI as it’s mainly for them.  So now the DMOs have to wait until they receive the master list from the state.


While practice administrators can get the TPI over the phone, that’s not sufficient for the DMOs.  They must have it in writing from the state in the portal or the welcome letter. But TPIs haven’t been available in the portal since it was upgraded either.


The result is that it is now taking months for these TPIs to show in the state’s master list for some providers.


Credentialing delays meant to entrap?

Another provider wrote us about our first article on credentialing “Credentialing Still a Disaster for Texas Medicaid Dentists.”

They wrote:

“This is so valuable. Thank you for sending this. I have been barking up the same tree for 12 years now. There is a gap in credentialing that only hurts dentists and their patients. This gap is the “way the state” tries to trap dentists into fraud as they try and take care of their patients when there is a gap in coverage. The positive intentions of quality dental providers trying to do right by their patients and Medicaid get punished for having dentists treat their patients when they are not yet credentialed because they care and are trying to keep a practice afloat when there is a gap.

“HHSC and DMOs attempt to capitalize on this gap, by not having to pay for treatment for a time. This gap should be completely eliminated with a 10-day temporary credentialing during the gap time. This would allow no gap or delay in treatment. It would then allow temporary or provisional coverage so patients can not be sent to other offices or locations or a practice’s patient pool is not decimated by one dentist leaving.

“There is no excuse or reason that credentialing should take longer than 30 days and yet sometimes it takes 60, 90, 120 days and even up to 9 months. This is simply unacceptable. The treatment gap must be eliminated. If a dental board approves a dentist without limitations, certainly a Medicaid provider should be credentialed without provisions.

“This is just a problem that keeps lingering when the solution and fix is so easy.”


Can Medicaid dentists survive?

With Texas HHS out of the loop, one has to ask how much of this can Medicaid dental providers survive.

D’oh! Maybe the Simpsons have moved to Texas.

One Response

  • So who is the nameless, faceless bureaucrat who unilaterally decided that TMHP would no longer issue TPI numbers? That person needs to go. Give us a name!

Leave a Reply

Your email address will not be published. Required fields are marked *