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Provider Information Validation on LTC Claims Beginning June 10, 2022

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Beginning June 10, 2022, provider information on Long-Term Care (LTC) claims will be validated using data stored in the NPPES (National Plan and Provider Enumeration System) and the TMHP Provider Enrollment and Management System (PEMS). This enhancement will ensure consistency of provider information and help prevent claim rejection.

The following data will be validated for attending and referring providers:

  • National Provider Identifier (NPI)
  • That dates of service on the claim are within the Texas Medicaid Enrollment period(s)
  • Provider Type Qualifier
  • First and Last Name

For more information about using PEMS, providers can refer to the article, “TMHP Provider Enrollment and Management System (PEMS) Training Materials Available.” For more information, contact the LTC Help Desk at 800-626-4117.