Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, 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.
Provider enrollment functions are available through the Provider Enrollment and Management System (PEMS), and there are two ways to enroll performing providers in PEMS:
Groups may add performing providers through a group-initiated request for enrollment by following these instructions:
- Access the group enrollment and navigate to the Practice Location Information page using the left navigation.
- Scroll to the bottom of the page and click the +Add Performing Provider
- A pop-up window will be displayed. Enter the performing provider’s National Provider Identifier (NPI) and answer a few more questions.
- After completion of the pop-up window, a new request will be started to add the performing provider to the group.
- Complete and submit the request.
Performing providers may add themselves to a group using their individual user account by following these instructions:
- Access your individual enrollment and navigate to the Practice Location Information page using the left navigation.
- Click the +Add Practice Location
- Answer No to the question, “Do you bill for services at this location?”
- Answer Yes to the question, “Are you a member of a group at this location?”
- Enter the Group NPI and select the Group Location (if the location does not appear, reach out to the group to see if the location is still awaiting enrollment and/or ask the group which location to add).
- Click Add Practice.
- Complete the pages for the location. If there are any additional practice locations, they can be added on the same request.
Important: Because PEMS has changed from a Texas Provider Identifier (TPI) to an NPI management basis, messages will now be shown on the PEMS message board at the NPI level. In Provider Enrollment on the Portal (PEP), it was managed at the location level. Providers are likely to see messages on their dashboard that are unexpected because of the distribution of information at the NPI level.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.