Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
Texas Medicaid & Healthcare Partnership (TMHP) is in the process of rolling out the Provider Enrollment and Management System (PEMS). Providers must use this new system to enroll.
This new system will be the single tool for enrollment, reenrollment, revalidation, and maintenance requests (maintaining/updating provider enrollment record information).
PEMS will automate and streamline the provider enrollment process by removing the requirement of the use of paper forms, thereby simplifying the process for providers to complete their National Provider Identifier (NPI)-based enrollment.
Upon deployment, PEMS will replace Provider Enrollment on the Portal (PEP) and the Provider Information Management System (PIMS).
The PEMS Roll-out Will Follow a Phased Approach
- Beginning September 1, 2021: Some Children with Special Health Care Needs-Family Support Services (CSHCN-FSS), Kidney Health Care (KHC) program, and long-term services and supports (LTSS) providers will participate in a soft launch of PEMS. Soft launch participation will be based on interest.
- From September to November, 2021: TMHP will begin testing PEMS functionality for acute care and long-term care providers. Participating providers will use a test environment to practice enrollment and record management tasks.
Feedback from these phases will help the development of the system and ensure PEMS meets the needs of providers.
December 13, 2021: All Providers Will use PEMS
TMHP will post more information about the upcoming changes, including provider training and resources prior to implementation.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.