If you are Texas Children’s Health Plan Member, we have tips that can help you deal with the severe weather. Learn more
Si eres miembro de Texas Children’s Health Plan, tenemos consejos que pueden ayudarte a lidiar con el clima severo. Aprende Más
Date: May 30, 2025
Attention: Providers
Call to action: This communication serves as a reminder of the National Provider Identifier (NPI) requirement for the service facility location, as outlined in the Texas Medicaid Provider Procedures Manual (TMPPM), Section 6: Claims Filing, TMPPM, 6.2.3, Claims Filing InstructionsPer the TMPPM:
“Facility Provider field blank or invalid. When place of service (POS) is anywhere other than home or office, the facility’s NPI must be present. If the NPI is not known, enter the name and address of the facility. Consult the software vendor for this field’s location on the electronic claims entry form.”
How this impacts providers: Claims submitted without the service facility NPI number in loop 2310C (CMS-1500) will be rejected at the clearinghouse level.
Next step for Providers: Providers must ensure compliance with this NPI requirement. Please work with your clearinghouse or billing software vendor to confirm that the NPI is correctly captured and submitted.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.