Skip to main content

You must have JavaScript enabled in order to access this part of the site. Please enable JavaScript and then reload this page in order to continue.

Provider Enrollment and Management System (PEMS) Post-Deployment Update

Last updated on

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.

Since the December 13, 2021, deployment of the Provider Enrollment and Management System (PEMS), Texas Medicaid & Healthcare Partnership (TMHP) has heard from many providers and used their feedback to enhance the provider user experience.

The topics listed in this notification highlight the most frequent issues about which providers indicated that they need additional support. This is the second edition of this list, following up the first edition that was originally posted on February 28, 2022.



LTC/PEMS Medicare Bypass

There are many questions related to the Medicare enrollment requirements for Long-Term Care (LTC) Program Providers.

TMHP is developing a system change to remove the Medicare requirements for LTC Program enrollment applications. This system change will be implemented by the end of March.  Additional information is provided here:



Practice Location Data Visibility

There was an issue noticed when large group providers were trying to access the practice location page and experienced system time out errors.

TMHP devised a system enhancement to restructure the process that increased bandwidth to allow full data visibility for group providers with a large number of practice locations. This enhancement was implemented on March 3, 2022.


Resolution – Tentatively Targeting March 2022

PEMS Instructional YouTube Videos

There are many questions regarding how to perform common enrollment actions and file maintenance updates in the new PEMS system.

TMHP is developing a series of instructional “how to” videos that detail the steps required to update provider enrollment records. The completed series of videos will be live on the TMHP YouTube page later in the month. Follow this link for instructions regarding how to address a change of ownership (CHOW) scenario: What is a CHOW?



PEMS System Releases

TMHP is completing system releases on a weekly basis as we continue to enhance and improve the PEMS system based on provider feedback.

TMHP  is completing weekly system releases to incorporate system enhancements and improvements. The latest system release was on March 10, 2022, and includes multiple system improvements. Providers can expect recurring system releases weekly through March.

The items below were initially published in the communication provided on February 28, 2022. There are no material changes and TMHP remains on-track for the system enhancements as identified below.


Resolution – Tentatively Targeting April 2022

Enrollment effective date

The Texas Health & Human Services Commission (HHSC) is revising the policy for Medicaid enrollment effective dates to again allow retroactive enrollment to the Medicare certification date for providers with the same Medicare and Medicaid risk category. This will require systems changes to implement and will be applied retroactively to providers that meet risk category criteria and submitted a Medicaid enrollment application on or after December 13, 2021.

TMHP is working with HHSC to implement system changes per revised HHSC policy. It is HHSC’s intent to systematically reprocess any claims that were denied as a result of this issue; the reprocessing of claims will occur after the system modification.


Resolution – Tentatively Targeting March 2022

Performing Provider Enrollment

Currently, multiple enrollments for performing providers or multiple locations under one National Provider Identifier (NPI) cannot be initiated concurrently. The reason for this limitation is to prevent multiple requests from updating the same information and causing conflicts.

TMHP is working with HHSC to prioritize this system change and working on a solution to allow these transactions to be started concurrently.

Enrolling Performing Providers in PEMS

Clarification and Guidance

Frequently asked question: How do you add a performing provider to a group?

No system change is required. For additional guidance, click here.

Dashboard View NPI level

Clarification and Guidance

Clarification for users with dashboard rights: Users have described seeing messages that are not related to their location.

Dashboards now include all locations under an NPI. This additional content is a change from the previous system and is due to a change from Texas Provider Identifier (TPI) to NPI hierarchy. For additional guidance, click here.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.