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.
Providers must update certain fields in the Provider Enrollment and Management System (PEMS) for their License/Certification/Accreditation and W9/Tax information that is not editable under the Attachments request type. Provider requests will be rejected if not submitted on the correct request type.
Providers should follow these instructions for provider maintenance requests (maintaining and updating provider enrollment record information) in PEMS:
PEMS Maintenance – Licenses
For license, certification, or accreditation updates, providers must submit a PEMS Maintenance – Licenses request and update the required fields.
PEMS Maintenance – W9/Tax Information
For W9/Tax information updates, providers must submit a PEMS Maintenance – W9/Tax Information request and update the required fields.
Note: If the provider already has a specific maintenance request open for a given National Provider Identifier (NPI), a PEMS request number will be present under Pending Change Request Number, the Request Status field will be populated, and the Request Action button will change to Open Request.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.