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Request for Pharmacies to Check That Pharmacy Licenses Are Current in PEMS

Last updated on 4/29/2022

The Texas Health and Human Services Commission (HHSC) and Texas Medicaid & Healthcare Partnership (TMHP) have assumed enrollment processing for the Vendor Drug Program (VDP) through the TMHP Provider Enrollment and Management System (PEMS).

The Vendor Drug Program is requesting that pharmacies check that their license information is up to date and in compliance with Texas Medicaid enrollment policies. License information includes license type, license number, and license expiration date. Note that these licenses are for pharmacy enrollments, not pharmacist enrollments.

Inaccurate license information in PEMS can affect timely claims processing and cause other enrollment issues.

HHSC will give pharmacies advanced notice of the date that the claims denial will be effective.

Pharmacies must have a current license to remain active and to continue participating in Texas Medicaid and all other Texas state health-care programs.

If a license requires updating, pharmacies must update license information by submitting a maintenance request through PEMS.

Update Provider Information in PEMS

Follow these steps to update provider information in PEMS:

  1. Log into your TMHP User Account, and click Provider Enrollment and Management System.
  2. Select the relevant National Provider Identifier/Atypical Provider Identifier (NPI/API) that requires the update.
  3. Click (the ellipses), click View, and then click Edit Enrollment Record.
  4. Click Create Request for the appropriate maintenance request type.
  5. Allow up to 30 business days for processing.

HHSC requests that pharmacies complete this activity as soon as possible.

If HHSC gives notice of the claims denial effective date, and the provider license is expired after that effective date, TMHP will deny pharmacy claims. Claims will be denied until TMHP approves the update maintenance request and then updates the license information.

For more information, call the TMHP Contact Center at 800-925-9126.