Skip to main content

Provider Enrollment Revalidation Extensions

Last updated on

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.

Federal law requires all providers to revalidate their Medicaid enrollment at least every five years. However, due to the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) has provided extensions to the revalidation date until further notice.

TMHP will notify providers 120 days before their recalculated enrollment end date. However, the ability to submit a revalidation application is currently open to all providers who wish to get ahead of the process. Providers are strongly encouraged to avoid potential enrollment delays by submitting revalidation applications immediately before the end of the current COVID-19 public health emergency revalidation waiver.

Provider Enrollment Requirements

Texas Medicaid, Children with Special Health Care Needs (CSHCN) Services Program, and Family Planning Program providers should confirm their current information regularly. Providers can view their enrollment information through the Provider Information Management System (PIMS).

To reduce delays in application processing during the revalidation process, providers are encouraged to update the following data elements prior to submitting a revalidation application:

  • First and last name
  • Organization name
  • Social Security number
  • Date of birth
  • Employer’s Tax Identification Number and legal name

Providers can refer to the Texas Medicaid & Healthcare Partnership (TMHP) Provider Information Management System (PIMS) User Guide for information on how to use this tool.

Providers can refer to the following related articles for information:

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.