Important: The information in this article has now been updated. The updated information can be found here: Update to Provider Enrollment Revalidation Extensions to End Due to COVID-19 PHE
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.
Effective February 28, 2022, the Texas Health and Human Services Commission (HHSC) is ending the flexibility that extended revalidation dates due to the COVID-19 public health emergency (PHE).
Providers that were due for revalidation effective March 1, 2020, through February 28, 2022, will be given a post-PHE grace period to complete the revalidation process. TMHP will notify providers in January 2022 of their recalculated enrollment end date and again 120 days prior to their enrollment end date.
However, the ability to submit a revalidation application is currently open to all providers that wish to begin the process. Providers are strongly encouraged to avoid potential enrollment delays by submitting revalidation applications immediately.
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) and after December 2021 in the new Provider Enrollment and Management System (PEMS).
To reduce delays in application processing during the revalidation process, we encourage providers 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.
Additional information related to PEMS is available on the TMHP website: The Benefits of PEMS
Providers can refer to the following related article 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.