Provider Change of Ownership Form - TMHP.com 2025

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The document outlines the procedures and requirements for a change of ownership of a facility participating in Medicare and Medicaid programs. It specifies that such a change does not terminate Medicare eligibility, allowing continued Medicaid participation if new owners comply with certain conditions, including obtaining recertification, completing enrollment forms, and providing necessary documentation. The document also includes a questionnaire to gather information about the previous and new owners.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I contact Medicaid provider enrollment in Missouri?

If you have questions or need assistance completing the enrollment forms, contact the Provider Enrollment Unit by e-mail at MMAC.providerenrollment@dss.mo.gov . For questions regarding billing, contact the Provider Communications Unit at 573-751-2896.

How do I contact AHCCCs provider enrollment?

For assistance on requesting the temporary 14-digit application ID or requesting domain permission, please contact AHCCCS Provider Assistance at 602-417-7670, option 5, or email AHCCCS Provider Enrollment at APEPTrainingQuestions@azahcccs.gov.

What is the provider enrollment process?

In the most basic terms, provider enrollment (sometimes referred to as payer enrollment) is the process through which healthcare providers apply to be included in a health insurance network. As an in-network provider, you will be able to treat patients who carry that insurance and be reimbursed for your services.

How do I change my Texas Star Medicaid provider?

You can learn more by calling the Texas STAR Program Helpline at 1-800-964-2777. You can request to change your health plan at any time for any reason. If you call to change your health plan on or before the 15th of the month, the change will take place on the first day of the next month.

How do I contact Texas Medicaid provider enrollment?

For additional enrollment walkthrough assistance please contact the TMHP Contact Center (800-925-9126) or TMHP-CSHCN Services Program Contact Center (800-568-2413) or send an email to provider.relations@tmhp.com to request assistance with enrollment questions.

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What is the Texas Medicaid disclosure of ownership form?

Form 5871-S is completed and submitted as a condition of approval or renewal of a Texas Medicaid enrollment application or a contract agreement between the disclosing entity (applicant/provider) and HHSC for any services program. A full and accurate disclosure of ownership and control interest is required.

Provider Change of Ownership Form - TMHP.com 2025

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How do I contact Medicaid provider enrollment in Missouri?

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What is the provider enrollment process?

How do I change my Texas Star Medicaid provider?

How do I contact Texas Medicaid provider enrollment?

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What is the Texas Medicaid disclosure of ownership form?

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