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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.
The Texas Medicaid & Healthcare Partnership (TMHP) has recently implemented a new Provider Enrollment and Management System (also known as PEMS), effective December 13, 2021. Because of the transition to the new enrollment system, all existing applications in the former enrollment system, Provider Enrollment on the Portal (PEP), must be completed by February 15, 2022. Applications that are not approved for enrollment by this date will be closed, and providers will be required to start a new application in the PEMS system.
Providers with applications that are pending for additional information are encouraged to submit the required response as early as possible to avoid processing delays that could result in application closure. If providers have an incomplete application in PEP, they will not have access to the PEMS profile for maintenance updates until the PEP application has been completed and closed. Providers can proactively request closure of a PEP application in writing by sending a request to TMHP by fax to 512-514-4214 or by mail to:
Texas Medicaid & Healthcare Partnership
PO Box 200795
Austin, TX 78720-0795
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.