Medicaid Providers Not Re-enrolled by September 24 Will Automatically be Disenrolled on the 25th

Medicaid symbolThe latest quarterly report issued by IG last week reminds Medicaid providers that CMS has a deadline of September 25 for re-enrollment of all Medicaid providers (deadline originally March).   All providers who enrolled prior to January 1, 2013, must complete the re-enrollment process by that date which is five weeks away.

Disenrolled on the 25th

The truth of the matter, per the TMHP website, is that the re-enrollment date is Saturday, September 24.  If a provider isn’t enrolled by Sunday, September 25, they will be automatically disenrolled from Texas Medicaid.

Nice to know your government works on the weekend.

IG report indicates Provider Integrity Research team is working on it

Per the IG report, IG’s  Provider Integrity Research team  is under the gun to ensure that all applications will be screened by the deadline and apparently a lot of providers had not reapplied yet making their jobs difficult as they basically require ten days to do background checks.  

It should be kept in mind that the period for the report ended in June so was probably written in that month or early July.

The IG conducts background checks on certain providers applying for enrollment or re-enrollment in the Medicaid program. This quarter, the Provider Integrity Research team implemented changes in its workflow and job responsibilities to better handle the increase in background checks, eliminate bottlenecks, improve internal performance metrics, and meet the 10-day statutorily required timeframe.

The team works closely with HHSC’s MedicaidCHIP Division to promote a better enrollment experience for providers, monitor Texas Medicaid and Healthcare Partnership contract compliance, and develop synchronous systems and processes.

The new CMS deadline specifying that all Medicaid providers must re-enroll by September 25, 2016, looms on the horizon and will soon generate a burst of new work.

As of May 31, 37,145 National Provider Identifiers (NPIs) still must submit re-verification applications in order to remain enrolled. This corresponds to nearly 200,000 affiliated individuals (including owners and principals) who must be screened by the IG in order to meet the re-verification deadline.

TMHP deadline for guaranteeing re-enrollment was June 17

However, the TMHP web page on Medicaid re-enrollment states the following:

Texas Medicaid established an application submission deadline of June 17, 2016 which ensured providers of continued enrollment if a complete application was submitted by that date. Providers that missed the application submission deadline may still be able to complete the revalidation process by the federal deadline of September 24, 2016. While there is no guarantee that an application submitted now will complete the process by the September 24, 2016 deadline, submitting an application now provides the best possible chance of meeting the deadline.

If the application is not processed by September 24, 2016, the provider will be dis-enrolled from Texas Medicaid with an effective date of September 25, 2016.

To avoid disenrollment on September 25, 2016, and possible disruptions in claims payment, providers should submit a revalidation application to the state or TMHP today.

Check your enrollment status online

Per TMHP, to view your status:

1. Go to the TMHP website at
2. Log into My Account as a provider administrator.
3. Select 
Provider Information Management System (PIMS), which is located under “Manage Provider Accounts.”
4. The PIMS Administrator Screen will display two new columns: “Federal Re-enrollment Complete” and “Federal Re-enrollment Date.”

NPI Federal Re-Enrollment Complete Federal Re-Enrollment Date






“Yes” indicates that your re-enrollment is complete, and you are compliant with the ACA.


“No” indicates that you have not re-enrolled and are not compliant with the ACA..


The date displayed in this column is your next re-enrollment date. If you do not re-enroll before this date, your enrollment will be terminated. Your TPI will be automatically deactivated without advance notice. Providers that have not completed re-enrollment will see a date of 9/25/2016 displayed. This is the
federally-mandated date for all providers to complete re-enrollment.

5. You can also click on any of the listed NPIs to go to the PIMS information Change Screen. The PIMS Information Change Screen will display two new fields: “Federal Re-Enrollment Complete” and “Federal Re-Enrollment Date.” The Federal Re-Enrollment Complete field is located under the Plan Affiliation, and the Federal Re-Enrollment Date is located under the Group Affiliation. 

Note: Associated performing providers will only be displayed if they are linked to the Provider Administrator account.

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