Get Tx Tmhp F00113 2018-2026

The TX TMHP F00113 form is essential for documenting changes in ownership for Texas Medicaid providers. This guide will assist you in accurately completing the form online, ensuring that all necessary information is provided for processing.

Follow the steps to fill out the TX TMHP F00113 online.

1. Click ‘Get Form’ button to access the TX TMHP F00113 form and open it in your preferred online editor.
2. Begin by filling in the previous owner's information. Input the Previous Texas Provider Identifier (TPI) and specify both the current and new fiscal year-end dates.
3. Check the applicable reason for the change of ownership by selecting one of the provided options: change in lease, merger, or termination.
4. Provide the effective date of the change of ownership and indicate whether the Centers for Medicare and Medicaid Services (CMS) considered this a change of ownership.
5. If CMS considered it a change of ownership, complete the details for the previous owner, including short period dates, name, address, tax ID number, contact name, and telephone number.
6. Proceed to the new owner's information section. Indicate whether the new owner assumes liability and fill in the short period dates for the new owner as well as the Medicare intermediary.
7. Complete all relevant details for the new owner, including name, address, tax ID number, contact name, and telephone number.
8. Fill out the statement of change of ownership, specifying whether the new owner will accept assets and liabilities of prior periods. Complete the required statements regarding authority and responsibilities.
9. If the previous owner remains liable, provide their name, address, and contact information for follow-up.
10. Review all the information entered for accuracy before saving changes. You can then download, print, or share the completed form as needed.

Complete the TX TMHP F00113 form online today for a streamlined change of ownership process.