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.
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:
The video series can also be accessed on the TMHP YouTube channel at the following link:
Additional information related to PEMS is available on the TMHP website:
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
- New Enrollment
- 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.
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.