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

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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.

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 have indicated that they need additional support. This is the third edition of this list, following the first edition that was posted on February 28, 2022.

Topic

Resolution

Helpful Tips to Reduce Enrollment Application Deficiencies

Check Your Information:

The name on your professional license, your practice location, your National Provider Identifier (NPI), and your Social Security number must match both what is on file with Medicare and what is listed in the Texas Medicaid enrollment application.

Attaching Documents:

  • If you participate in the Electronic Funds Transfer (EFT) Program, don’t forget to attach either a voided check or back letter.
  • If your organization is a corporation, limited liability company (LLC), or partnership, be sure to attach the required organizational chart.

If you’re not sure how to attach the required additional documentation, visit TMHP’s YouTube channel and watch one of the newest how-to videos, as mentioned below:

Adding Attachments – YouTube

Topic

Resolution

Revalidation

Providers must complete their revalidation before the end of their enrollment period. Providers can complete their revalidation in PEMS up to 120 calendar days before their current due date.

Providers may find more information at Provider Enrollment under “Determine Your Application Type” and start their revalidations in PEMS.

Topic

Resolution

LTC/PEMS Medicare Bypass

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 2022.

Additional information is provided here.

Topic

Resolution

Practice Location Data Visibility

An issue was 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.

As of March 3, 2022, providers should see marked improvements.

Topic

Available Now

PEMS Instructional YouTube Videos

TMHP has developed a series of instructional how-to videos that detail the steps required to update provider enrollment records.

To view the complete series of instructional how-to videos, click here.

Topic

Resolution

PEMS System Releases

 

TMHP is completing weekly system releases to incorporate system enhancements and improvements based on provider feedback. The latest system release was on March 10, 2022, and included multiple system improvements related to enrollment, revalidation, and improving provider experience.

On March 31, 2022, the system release will include improvements related to the optional LTC Medicare requirement and allowing concurrent transactions for performing providers.

Topic

Resolution

 

Enrollment Effective Date

 

The policy for Medicaid enrollment effective dates will be revised to again allow retroactive enrollment to the Medicare certification date for providers with the same Medicare and Medicaid risk category.

System enhancements will be applied retroactively to providers that meet risk category criteria and have submitted a Medicaid enrollment application on or after December 13, 2021.

Additionally, TMHP will systematically reprocess any claims that were denied as a result of this issue; the reprocessing of claims will occur by the end of May after the system modification is implemented at the end of April 2022.

View previous postings below:

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