ALL providers must complete HHSC’s Financial Verification Questionnaire by June 20th, or all supplemental and directed payment program funding could be held up until the information is submitted and verified by HHSC. Click here for the link.
To preview the information provided in the questionnaire, click U to download a spreadsheet.
Depending on your ownership type and the programs in which you are enrolled, you may need to submit more than just one form. Please see below for clarification.
If you are a public hospital system:
- If you ONLY participate in hospital programs (you are NOT In RAPPS, QIPP, or TIPPS), you should submit one form by clicking the link on HHSC’s email below, and use the hospital’s main NPI. For the question about do you submit IGT, receive payments, or both, you would answer “Both”.
- If you participate in BOTH hospital programs and non-hospital programs (such as RAPPS, QIPP, or TIPPS), you will need to submit 2 forms. HHSC has said that the hospital should submit one form by clicking the link on HHSC’s email below (for the question about do you submit IGT, receive payments, or both, the hospital would answer “Both”), and the attached form may be used to list out all RAPPS clinics, QIPP nursing facilities, and TIPPS provider groups (instead of submitting separate forms for each entity). Email the completed attached form to PFD_Payments@hhs.texas.gov.
If you are a private hospital system:
- If you only participate in hospital programs (you are NOT in RAPPS, QIPP, or TIPPS), 2 forms will need to be submitted. Submit one form for your hospital by clicking the link on HHSC’s email below, and use the hospital’s main NPI. For the question about do you submit IGT, receive payments, or both, you would answer “Receive Payment Only”.
The hospital district who submits your IGT should also submit a separate form by clicking the link on HHSC’s email below. For the question about do you submit IGT, receive payments, or both, they would answer “IGT Only”. - If you participate in BOTH hospital programs and non-hospital programs (such as RAPPS, QIPP, or TIPPS), you will need to submit 3 forms. HHSC has said that the hospital should submit one form by clicking the link on HHSC’s email below (for the question about do you submit IGT, receive payments, or both, the hospital would answer “Receive Payment Only”), and the attached form may be used to list out all RAPPS clinics, QIPP nursing facilities, and TIPPS provider groups (instead of submitting separate forms for each entity). Email the completed attached form to PFD_Payments@hhs.texas.gov.
The hospital district who submits your IGT should also submit a separate form by clicking the link on HHSC’s email below. For the question about do you submit IGT, receive payments, or both, they would answer “IGT Only”.
If you have any questions, please let us know.
Please email us to let us know when you have submitted the form, so we can ensure no one has their funding held up.
Shonna Cannaday, shonnac@daacg.com
Sherri Powell, sherrip@daacg.com