This article has been updated. For the updated information, click here.
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.
This is an update to the article titled “Existing Enrollment Applications in Provider Enrollment on the Portal (PEP) Must Be Completed by February 15, 2022,” which was posted on this website on January 13, 2022.
Due to the recent transition to the new Provider Enrollment and Management System (PEMS), all applications submitted through the previous enrollment system, Provider Enrollment on the Portal (PEP), were expected to be completed by February 15, 2022. This transition date has been extended to March 15, 2022.
Applications that are in-flight after March 15, 2022, will be closed, and providers will be required to submit the application through PEMS. Any applications completed through the legacy system will not be eligible for re-opening. To avoid delays when providers start using PEMS, visit the National Plan and Provider Enumeration System (NPPES) website to ensure all taxonomies used to bill for Texas Medicaid services are associated with the provider’s National Provider Identifier (NPI).
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.