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Texas medicaid provider enrollment 2026
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- Click ‘Get Form’ to open the Texas Medicaid Provider Enrollment Application in the editor.
- Begin with Section A: Provider of Service Information. Fill in your provider type, specialty, and demographic information accurately.
- Proceed to Section B: Disclosure of Ownership and Control Interest Statement. Complete all required disclosures about ownership interests.
- In Section C, if enrolling as a group practice, provide details for all performing providers associated with your application.
- Complete Section D: Provider Information Form (PIF-1) ensuring all fields are filled correctly, especially the physical address where services will be rendered.
- Review the HHSC Medicaid Provider Agreement carefully and sign it to confirm your understanding and compliance with the terms.
- 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!
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