Retroactive Enrollment Periods and Claims Reprocessing
The Texas Medicaid & Healthcare Partnership (TMHP) and the Texas Health and Human Services Commission (HHSC) have developed a process to modify enrollment period effective dates for providers that meet the following criteria:
- Have been disenrolled from Texas Medicaid for failing to revalidate on-time between November 1, 2023, and December 12, 2024.
- Successfully reenroll or revalidate in Texas Medicaid by May 31, 2025.
These flexibilities are solely in relation to providers who are disenrolled for failure to complete their revalidation timely. Disenrollments for other reasons, such as voluntary disenrollment; substantiated allegations of fraud, waste, or abuse; or expiration of licenses will continue to occur according to existing business processes.
What Providers Need to Know
Claims Reprocessing
- Providers must submit previously rejected claims that were not accepted due the Provider not being enrolled with Texas Medicaid.
- Community First will override timely filing denials for impacted claims as applicable.
- Providers will not need to appeal. Community First will assess previously denied claims for appropriate payment affiliated with the revalidation flexibilities.
- Providers will not be entitled to interest on claims affiliated with the revalidation flexibilities.
For questions pertaining to this notice, please contact ProviderRelations@cfhp.com.
For more information, please visit the TMHP website at:
Retroactive Enrollment Periods and Claims Reprocessing | TMHP
Please check the Provider Notices page on Community First Health Plans website for additional updates:
Provider News – Community First Health Plans
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6294. You can also contact your Provider Relations Representative directly.
To access all Provider alerts:
- Log into the Community First Provider Portal
- Go to CommunityFirstHealthPlans.com/Provider-News
- Sign up for the Community First Provider eNewsletter