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Medicaid Administrative Claiming (MAC)
Contracting Information
(ECI, MH/IDD, LHD, and ISD Programs)

Instructions

Please Note: Fully executed contracts remain open-ended unless terminated by the contracting entity or by the Texas Health and Human Services Commission (HHSC). The entity will not be required to resubmit these documents annually. The entity is responsible for keeping all contact information up-to-date and must adhere to all policy/procedures as directed by HHSC.

Forms

All participation documents must be sent to the following address:

HHSC Rate Analysis
Mail Code H-360
P.O. Box 149030
Austin, TX 78714

1) Intergovernmental Cooperation Agreement for each program:

2) Business Associate Agreement (For ALL programs) (.pdf)

3) Application for Texas Identification Number (for ALL programs) (.pdf)

Please note: All entities participating in the MAC program must fill out the Texas Identification Number Application (also known as a Payee Identification Number).

A Texas Identification Number (TIN) is a number assigned by the Comptroller's Office for the purpose of identifying any party receiving a payment from the State of Texas. The use of this number on all billings will reduce the time required to process billings to the State of Texas. In assigning a TIN, the Comptroller's office may use any of the following numbers:

  • a Social Security Number,
  • a Federal Employer's Identification Number, or
  • a Comptroller-Assigned Number when neither of the above is available or appropriate.

  • 4) Vendor Direct Deposit Form (.pdf) (for ALL programs)

    If the entity's financial institution, account, number, and/or account type changes, this form must be re-submitted to HHSC.

    5) Vendor Information Form (.doc) and Instructions (for ALL programs)

    1. Please note that for purposes of this form, the entity is the "Contractor".
    2. Complete the following sections
    3. a. Section 1: Contractor's General Information - Please respond to questions in this section.
      b. Section 2: Contractor's Contact Information -
      i. Person Who Will Sign the Contract (left-hand side):
      1. Fill in the contact information of the entity representative that will sign this Vendor Information Form.
      2. This must be the same person who signed the Intergovernmental Cooperation Agreement.
      ii. Point of Contact for Contract (right-hand side):
      1. Fill in the contact information of the entity representative that will serve as the primary/point of contact.
      iii. These may be the same person.
      c. Section 3: Contractor's Authorized Signature - Please have the entity representative, indicated in Section 2, sign the form. Please document the date of signature and phone number.
    4. Submit one original, signed copy along with the entity's remaining participation documents.

    6) MAC Program Operating Plan (for ISDs only)

    An approved Medicaid Administrative Claiming Program Operating Plan (MAC POP) is required in order for the school district to participate and receive reimbursement in the MAC program.  In addition to submitting the MAC POP, the school district is required to update and maintain all contact information in the State of Texas Automated Information Reporting System (STAIRS).  Once a MAC POP has been approved, the district is required to update STAIRS should program contacts change.


    Contact Rate Analysis MAC

    Send email to Rate Analysis MAC Mailbox


    Updated: October 11, 2013