You must have JavaScript enabled in order to access this part of the site. Please enable JavaScript and then reload this page in order to continue.

WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
-----------------------
AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

Disclaimer of Warranties and Liabilities

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the American Medical Association (AMA) is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with THHS, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the for egoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "accept".

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONTINUED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD, AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NO AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org.

3. U.S. GOVERNMENT RIGHTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements.

4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does no t directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT and other content contained therein, is with TMHP or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of the Agreement. The ADA is a third party beneficiary to this Agreement.

5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must exit from this computer screen.

Coming Soon: TMHP Provider Enrollment and Management System (PEMS)

Last updated on 10/29/2021

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’s (TMHP) Provider Enrollment and Management System (PEMS) is coming soon.

Provider enrollment functions will be available through PEMS, and providers must use this new system to enroll in Texas Medicaid.

PEMS will automate and streamline the provider enrollment process by removing the requirement to use paper forms, simplifying the process for providers to complete their National Provider Identifier (NPI)-based enrollment. Providers or individuals who do not provide health-care services and who are not required to have NPIs may have been issued Atypical Provider Identifiers (APIs). These providers should use their APIs.

PEMS Benefits

Using PEMS will result in the following benefits:

PEMS eliminates the need for multiple Texas Provider Identifiers (TPIs), allowing providers to interact with all Texas Medicaid records in a single, easy-to-use system.
PEMS will allow for Texas Medicaid enrollment in multiple state health-care programs from a single application. Real-time data validation will reduce errors and expedite the enrollment process.
The message dashboard will provide timely online email notifications and related correspondence.
PEMS will offer real-time availability to changes made to provider information and offer instant access to the status of provider enrollment applications.
PEMS will allow clients to locate providers faster with the expanded Online Provider Lookup search functionality.

PEMS Training and Resources

Users must have a username and password to access videos in the LMS. To obtain a username and password, click the “Don’t have an account? Sign up here” link on the LMS homepage and complete the new user registration.

A PEMS instructional video series is available on the TMHP Learning Management System (LMS) at the following link:

PEMS Instructional Video Series

The video series can also be accessed on the TMHP YouTube channel at the following link:

“Provider Enrollment & Management System Playlist” on YouTube.

Additional information related to PEMS is available on the TMHP website:

The Benefits of PEMS

PEMS Portal Effective December 13, 2021

Providers should plan for the following changes on December 13, 2021:

PEMS will replace Provider Enrollment on the Portal (PEP) and the Provider Information Management System (PIMS).
PEP and PIMS will no longer be available.
Paper applications for Texas Medicaid provider enrollment will be eliminated with the new online system.
Providers must have access to the internet to utilize PEMS, and use up-to-date internet browsers for optimum performance of the PEMS portal. Use Google Chrome or Microsoft Edge to reduce compatibility issues.

Set Up a TMHP Learning Management System (LMS) Account and a TMHP User Account

Providers should create TMHP accounts before enrollment transitions in December.

Set Up a TMHP LMS Account: This is a provider education portal. The portal has important training on TMHP systems, setting up user accounts, and how to access and use PEMS. For instructions, refer to the Learning Management System (LMS) Registration and Navigation Job Aid for Providers.
Set Up a TMHP User Account: To create a TMHP User Account, log in to the TMHP LMS and refer to the TMHP Portal Security Training Manual. The manual provides step-by-step instructions on activating and managing TMHP User Accounts.

The following educational materials will be available on October 29, 2021:

PEMS Best Practices Guide
Updated PEMS Computer-Based Training (CBT), which includes six modules:
General Information
Resources
New Enrollment
Reenrollment
Revalidation
Provider Management

These educational materials will be available in early November 2021:

TMHP Account Management Job Aid
TMHP Portal Security Training Manual

Portal Account Information

Providers should ensure that demographic and account information is kept up-to-date with the most current provider data.

National Provider Identifier and Taxonomies

Providers should verify that provider information on file and taxonomies match when enrolling in PEMS.

Taxonomy Attestation

The Centers for Medicare & Medicaid Services (CMS) assigns NPIs to clinicians through the National Plan and Enumeration System (NPPES). NPIs are used to track health care providers for billing and quality reporting.

HHSC is asking all providers with Medicaid enrollment to visit NPPES to ensure all taxonomies used to bill for Medicaid services are attested to the providers’ NPI.

To attest the NPI, login to the provider account at the NPPES website and review the taxonomies selected (attested) for the NPI.

Follow these directions for updating provider taxonomy information in NPPES.

Sign in using your CMS Identity and Access login credentials.
Scroll down to “Manage Provider Information.”
Under the “Action” column, click on the pencil icon to open the provider information editor.
Make any required changes to the individual categories.
Enter an HIE endpoint to allow communication through your HIE with other health care partners. This communication may help improve your HIE measures for the Merit-based Incentive Payment System (MIPS), as well as improve your overall care coordination and referral quality.
Make sure to click “Error Check” after all changes are made to ensure that the information provided is complete.
Click “Save and Return to Main Page” in the lower right corner. This will activate a dialogue window.
Choose “Complete NPI Application” to submit all entered changes to the NPPES.
Click “Main Page” on the top of the menu bar on the left to return to the NPPES main page. From here, you can make further changes or sign out from the upper right corner.

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