Texas medicaid provider change 2026

1. Click ‘Get Form’ to open the Texas Medicaid Provider Change form in the editor.
2. Begin by filling out the Provider Information section. Enter your name, primary taxonomy code, and either your nine-digit Texas Provider Identifier (TPI) or National Provider Identifier (NPI). Ensure this information is accurate to avoid delays.
3. In the Address Information section, select the appropriate option for modifications. If you are changing a physical address, provide both the current and new addresses. Remember that physical addresses cannot be P.O. Boxes.
4. Indicate your Communication Preferences by selecting how you wish to receive notifications—either by mail or email. If choosing email, ensure you provide valid addresses.
5. Complete the Demographic Information section by detailing languages spoken, office hours, and whether you are accepting new clients. This helps maintain accurate provider listings.
6. For Tax Information, enter your Federal Tax Identification Number (TIN) and ensure a W-9 form is attached if changes are made. Provide a signature at the end of the form to validate your request.

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