TX HHS Form 2097. Provider Contract Assignment Notification

The TX HHS Form 2097, Provider Contract Assignment Notification, is a crucial document that helps resolve changes in provider contracts for individuals receiving services from the Texas Health and Human Services Commission. This form notifies providers of changes to their contract, which may result from changes in business ownership, complete changes in ownership, or changes in the provider's license.

This notification form requires essential information, including the provider's name and address, as well as the HHSC case worker's contact details. The form also outlines the consequences of these changes, such as updates to service plans with new contract numbers or names. Providers may choose to continue services with the assigned provider or select a different one. If they wish to change providers, they can do so at any time.

The Provider Contract Assignment Notification is typically used in situations where there are changes to a provider's contract, and it is essential for individuals receiving services to be informed of these updates. Key features of this form include the requirement for providers to notify HHSC case workers of changes to their contracts and the option for recipients to select new providers if needed. By filling out this form, providers can ensure that all necessary information is shared with relevant parties.

• This form is used when there are changes to a provider's contract due to business ownership changes, complete changes in ownership, or changes in the provider's license.
• The form requires essential information, including the provider's name and address, as well as HHSC case worker contact details.
• Providers may choose to continue services with the assigned provider or select a different one.