SHARS Reimbursement Methodology

HHSC plans to release a notice through Fairbanks on September 30, 2022 which will indicate the effective date of these changes will be October 1, 2022.

Referrals and Prescriptions

It is important to note that the requirements for Occupational and Physical Therapy are different than Speech and Audiology.

Beginning November 1, 2022, students submitted for SHARS reimbursement who receive Speech and/or Audiology services need a Referral.  Referrals can be done by a physician or a SLP/audiologist.  If a SLP does the referral, he/she must have a NPI that is registered with Medicaid.  Not all SLPs must have an NPI.  Only the SLPs who do referrals; however, some districts are requiring all SLPs to get registered.

Occupational and Physical Therapy services require a prescription from a physician.  Only a physician can complete a prescription and he/she must have an NPI number that is registered with Medicaid.  OT and PTs do not need an NPI.

Terminology: Register with Medicaid and PEMS

“Register with Medicaid” means the provider completes an application with TMHP. In the past, the enrolling provider would get a Texas Provider Identifier (TPI) number.  That is no longer the case.  When the application is approved, they will be assigned a Legacy ID, but it is not included in the approval letter.  Only the NPI is required on SHARS claims, but the number must go through the TMHP registration process.  ONWARD asks to be notified when the NPI number for the therapist is approved through TMHP.

“PEMS” Provider Enrollment and Management System is the system in which provider will register through TMHP.  When your registration is complete, you will get a welcome letter.  You can also check on the website for the status of your application.  HHSC states that referrers “must be enrolled as individual practitioners and must use their individual NPI for claim submission.”  If you enrolled as an organization, TMPH advises that you submit another application to enroll as an individual practitioner.

TMHP has a process to assist individuals who are having difficulty with the enrollment process.  They advise individuals to call 800-925-9126 option 3: Provider Enrollment to escalate their case.  ONWARD recommends to have your NPI number available for the call and write down the TMHP Customer Service Representative you spoke with along with your ticket number for the call.

In summary, SHARS referrers and prescribers need to have a valid NPI and it must be registered with Texas Medicaid (TMHP).

504 Audiology

Guidance for 504 Audiology has been provided.  Pending federal approval, the effective date is October 1, 2022.