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

Topic

Current Status

LTC/PEMS Medicare Bypass

TMHP implemented a system change to remove the Medicare requirements for Long-Term Care (LTC) Program enrollment applications.

This system change was implemented March 31, 2022.

Additional information is provided here.

Topic

Current Status

Concurrent Performing Provider Application

Previously, multiple enrollments for providers or multiple locations under one National Provider Identifier (NPI) were not allowed concurrently to prevent conflicts if multiple requests asked to update the same information at the same time.

TMHP implemented a system change that was released March 31, 2022, to allow these transactions to be started concurrently.

Topic

Current Status

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 31, 2022, and included multiple system improvements related to enrollment, revalidation, and improving provider experience.

The release included improving performance for specific pages. An additional release is planned for April 7, 2022, to improve web page performance.

Topic

Current Status

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 modifications are tentatively expected to implement by the end of April 2022.

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.

TMHP will also systematically reprocess any claims that were denied as a result of this issue. This will occur by the end of May 2022.

Topic

Current Status

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 bank 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

Current Status

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 revalidation in PEMS.

Topic

Current Status

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 completed series of instructional how-to videos, click here.

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.