The Texas Health and Human Services Commission has issued a letter stating that effective June 10, 2022, provider information on long-term care (LTC) claims will be validated using data from the National Plan and Provider Enumeration System (NPPES) and the TMHP Provider Enrollment and Management System (PEMS). This validation aims to ensure consistency in provider information and prevent claim rejections. The data to be validated includes National Provider Identifier (NPI), dates of service, provider type qualifier, and first and last names. Providers must be enrolled in Texas Medicaid to avoid claim denial or rejection. By October 1, 2022, Intermediate Care Facilities for Individuals with an Intellectual Disability (ICF/IID) and Nursing Facilities (NF) providers must ensure that correct provider information is submitted to prevent claim rejections. Mismatches may result in explanations of benefits (EOBs) being assigned. Providers can refer to the Texas Administrative Code and contact the LTC Help Desk for more information.

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