Get Tx Tmhp Medical Transportation Program Provider Application 2015-2025

Completing the TX TMHP Medical Transportation Program Provider Application online is a crucial step for individuals and organizations looking to become a provider in the Medical Transportation Program. This guide provides step-by-step instructions to help users navigate the application process smoothly.

Follow the steps to effectively complete your application.

1. Click ‘Get Form’ button to download the TX TMHP Medical Transportation Program Provider Application and open it for editing.
2. Begin by filling in the 'Applicant Contact Information' section with accurate details about the designated point of contact for any application-related inquiries. Include their name, phone number, and email address as applicable.
3. In the 'Application Payment Form,' indicate the method of payment for the application fee and ensure that it reflects the correct amount, as specified in the guidelines.
4. Proceed to the 'Medical Transportation Provider Enrollment Application' section. Here, state the type of enrollment you're applying for, such as full risk broker or managed transportation organization, and provide the necessary demographic information.
5. Fill in the 'Disclosure of Ownership and Control Interest Statement' thoroughly. This requires listing all owners, partners, and major stakeholders and disclosing any ownership interests.
6. For entities, complete the 'MTP Principal Information Forms' (MTP-PIF1 and MTP-PIF2) for each principal involved in the application, providing details about their roles and any relevant affiliations.
7. Sign and date the 'Medical Transportation Provider Agreement' after reviewing the terms and ensuring compliance with all regulations. Original signatures are mandatory.
8. Once all sections are completed, save your changes, and prepare copies for your records. You may then proceed to download, print, and share the finalized application as needed.

Complete your TX TMHP Medical Transportation Program Provider Application online today to start your enrollment process.