View the Texas Medicaid Provider Profile

The Medicaid Provider Profile page shows the Medicaid services provided by your facility, along with the values and effective dates of Medicaid reimbursement calculations.

To access the Medicaid Provider Profile page, select Go To > Government Payor Research > Medicaid > Provider Profile. The Medicaid Provider Profile page opens.
In the Select State or Payer drop down list, select TX.
Select Go.
Enter the ten-digit National Provider Identification (NPI) number for the provider you want to review in the NPI or Provider Number field.
Enter a date in the Effective Date field if you want to view provider profile information for an effective date other than today.
Click Display Profile. The Medicaid Provider Profile information displays.
Note: To clear the results and return to original Medicaid Provider Profile page, click Reset.
Review your Medicaid Provider Profile information.

Note: The data that displays on the provider profile varies from state to state.

Texas Medicaid Provider Profile

The following table describes each of the fields on the Medicaid Provider Profile page for Texas Medicaid.

Field	Description
State or Payer	State or payer for the selected provider number
NPI or Provider Number	Provider’s tax ID number or ten-digit National Provider Identification (NPI) number required on all claims
Effective Date	Date on which the selected profile went into effect
Inpatient Acute Hospital
Standard Dollar Amount	Conversion factor used by Texas Medicaid to calculate DRG payments
OB Standard Dollar Amount	The standard dollar amount for obstetric patients.
Rural Delivery SDA	The amount for Rural Delivery SDA.
Inpatient Cost-to-Charge Ratio	The facility-specific inpatient charges by revenue center converted to costs using a cost-to-charge ratio for each revenue center
Inpatient Outlier Percentage	Facility specific CTC used in outlier calculations.
Universal Mean	Mean dollar value used in the calculation of outlier payments for qualifying provider accounts
Children’s Hospital	Indicates (Y/N) if the facility is a Children’s Hospital.
Rural Facility	Indicates (Y/N) if the facility is a Rural Facility.
Rockwall Facility	Indicates (Y/N) if the facility is a Rockwall County Facility.
PPC	Displays the PPC reduction.
PPR	Displays the PPR reduction.
UHRIP	Displays the Uniform Hospital Rate Increase Payment.
ACIA Rate	Displays the Average Commercial Incentive Award rate.
Outpatient Acute Hospital
Outpatient Cost-to-Charge Ratio	The facility-specific outpatient charges by revenue center converted to costs using a cost-to-charge ratio for each revenue center.
High Volume Percentage	High volume percentage adjustment
Low Volume Percentage	Low volume percentage adjustment
ER Reduction Group	Mandatory reduction of non-emergency ER codes.
UHRIP	Displays the Uniform Hospital Rate Increase Payment.
ACIA Rate	Displays the Average Commercial Incentive Award rate.
Hospital Ambulatory Surgical Center
NPI	Facility’s ten-digit National Provider Identification (NPI) number required on all claims
Provider #	Provider number
ZIP Code	Postal ZIP code for the service location
Locality Code	Locality code assigned to the provider