If you have received an Electronic Health Record/Promoting Interoperability incentive payment you do not want or that must be returned to HHSC because of an audit or determination of ineligibility, follow these steps to ensure the returned payment is credited properly:

TMHP Remittance Form

  1. Fill out the provider name, TPI, and TIN that corresponds to the PAYEE (recipient) of the EHR incentive payment, even if the recipient is different than the attesting provider.
  2. Write a comment at the bottom of the form designating the check as an "EHR Incentive Program payment refund."
  3. Send the form to:

Texas Medicaid & Healthcare Partnership
Accounts Receivable
PO Box 202948
Austin, TX 78720-2948