Out of Network Provider Enrollment
If a Provider or Facility is not a contracted Provider, the Provider/Facility must contact the El Paso Health Contracting and Credentialing Department regarding set up.
Out of Network Providers may submit the Provider Demographic Form and W-9 and Texas Provider Identifier (TPI) Letter via email to Contracting_Dept@elpasohealth.com or by fax to 915-298-7870.
Provider Demographic Form
W9 Form – Request for Taxpayer Identification Number and Certification
To be reimbursed for services rendered to Medicaid Members, Provider must be enrolled in Texas Medicaid. If an Out of Network Provider does not have a TPI number, the provider will not be eligible for reimbursement for services to a member participating in the STAR Medicaid Program. An Out of Network Provider must notify the El Paso Health Contracting and Credentialing Department of the TPI assignment through a formal written notification which may be the Texas Medicaid & Healthcare Partnership (TMHP) approval letter.
Out of Network Providers are subject to non-participating provider authorization and reimbursement guidelines.
For more information, please reference the Provider Manual, Out of Network Provider-Texas Provider Identifier.