Texas medicaid provider enrollment 2026

1. Click ‘Get Form’ to open the Texas Medicaid Provider Enrollment Application in the editor.
2. Begin with Section A: Provider of Service Information. Fill in your provider type, specialty, and demographic information accurately.
3. Proceed to Section B: Disclosure of Ownership and Control Interest Statement. Complete all required disclosures about ownership interests.
4. In Section C, if enrolling as a group practice, provide details for all performing providers associated with your application.
5. Complete Section D: Provider Information Form (PIF-1) ensuring all fields are filled correctly, especially the physical address where services will be rendered.
6. Review the HHSC Medicaid Provider Agreement carefully and sign it to confirm your understanding and compliance with the terms.
7. Attach any additional required documents such as IRS W-9 Form, Corporate Board of Directors Resolution (if applicable), and submit your application through our platform for processing.

Start filling out your Texas Medicaid Provider Enrollment Application today using our platform for a streamlined experience!