Medicaid Provider Agreement Form
Description
How to fill out Anchor Provider Agreement?
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FAQ
To be eligible for the PHC Program, Texas residents must be 21+ years old and require assistance to perform at least one of the activities of daily living, such as bathing, grooming, eating, or toileting. Their functional limitation must result from a medical condition and must be documented by a medical professional.
To enroll as a provider, go to and click on Provider in the upper left of the page, then click on Enrollment to open the online enrollment application. Providers who intend to only provide services to NH Medicaid's fee-for-service recipients only need to enroll with the state.
How to Enroll. Go to the Enrolling in the CSHCN Services Program page of the Texas Medicaid & Healthcare Partnership website. You can enroll online or print out the paper application form to complete and return to TMHP. If you have questions, call your local area TMHP provider relations representative.
Medicare Provider Agreement means an agreement entered into between CMS or other such entity administering the Medicare program on behalf of CMS, and a health care provider or supplier under which the health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the
Once the person has successfully obtained an approved MPN from ODM, he/she can apply to be a waiver provider with DODD. Visit for ODM provider enrollment and support. The ODM Provider hotline is 800-686-1516.
