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.
Reminder: The Texas Medicaid & Healthcare Partnership’s (TMHP) Provider Enrollment and Management System (PEMS) has been effective since December 13, 2021.
Provider enrollment functions are available through PEMS, and providers must use this new system to enroll in Texas Medicaid.
The new system is the single tool for provider enrollment, reenrollment, revalidation, change of ownership, and maintenance requests (maintaining and updating provider enrollment record information).
Enrollment in Texas Medicaid
Effective December 13, 2021, enrollment in Texas Medicaid is now done through PEMS:
- PEMS has replaced Provider Enrollment on the Portal (PEP) and the Provider Information Management System (PIMS). PEP and PIMS are no longer available.
- Paper applications for Texas Medicaid provider enrollment have been eliminated.
- Providers must have access to the internet to utilize PEMS and use up-to-date internet browsers for optimum performance of the PEMS portal. Use Google Chrome or Microsoft Edge to reduce compatibility issues.
- Log on to the TMHP.com Provider Enrollment webpage to begin online enrollment activities.
Texas Medicaid and Other Programs and Services Enrollment Types
The affected enrollment types are:
- Acute Care Services
- Comprehensive Care Program (CCP)
- Texas Health Steps Dental
- Texas Health Steps Medical
- Healthy Texas Women (HTW)
- Case Management
- Texas Health and Human Services Commission (HHSC) Long-term Care (LTC)
- Managed Care Organizations – Long-Term Services and Supports (MCO-LTSS)
- Pharmacy Services
- Medical Transportation Program (MTP)
- Kidney Health Care (KHC)
- Children with Special Health Care Needs (CSHCN) Services Program
- CSHCN Family Support Services (FSS)
- Children’s Health Insurance Program (CHIP)
TMHP User Account
PEMS is accessed through My Account. PEMS access is tied to the National Provider Identifier (NPI) or Atypical Provider Identifier (API) associated with the TMHP user account. Ensure that the NPI has all the current and correct information. After a TMHP user account is created, follow these best practices for account management:
- Assign at least two administrators.
- Update user permissions as staff changes occur.
- Look for reminders for upcoming enrollment tasks on the Message Dashboard.
Refer to the Portal Security Training Manual, which will be available soon, for help creating a TMHP user account.
Preparing to Enroll
Before accessing PEMS, providers need to verify they have all the required information:
- Licenses or certifications, if applicable
- Identification for the provider and any person who meets the definition of owner, creditor, principal, subcontractor, or managing employee
- Documentation related to disclosures, if needed
- Additional required documentation for program participation
Refer to the checklists on the PEMS Instructional Site for a detailed list of documents and information required to complete applications.
PEMS Training Materials Available on the TMHP Learning Management System (LMS)
The following training materials are available in the PEMS Learning Path on the TMHP LMS and Provider Enrollment Help on TMHP.com to help providers learn how to navigate and use PEMS:
- PEMS webinar recordings
- Provider Frequently Asked Questions (FAQ) about PEMS
- The following computer-based training (CBT) modules:
- “General Information”
- “New Enrollment”
- “Provider Management”
- PEMS Video Series
- Video titled “PEMS vs. PEP”
- “Quick Start Guide to Using PEMS”
- “PEMS Best Practices Guide”
Note: Providers must have a username and password to access the above materials on the LMS. To learn how to obtain a username and password, click here.
The Centers for Medicare & Medicaid Services (CMS) assigns NPIs to clinicians through the National Plan and Enumeration System (NPPES). NPIs are used to track health-care providers for billing and quality reporting.
HHSC asks all providers with Medicaid enrollment to visit NPPES to ensure that all taxonomies used to bill for Medicaid services are attested to the providers’ NPI. To attest the NPI:
- Login to the provider account at the NPPES
- Review the taxonomies selected (attested) for the NPI.
Next, follow these directions for updating provider taxonomy information in NPPES:
- Sign in using your CMS Identity and Access login credentials.
- Scroll down to “Manage Provider Information.”
- In the “Action” column, click on the pencil icon to open the provider information editor.
- Make any required changes to the individual categories.
- Enter a Health Information Exchange (HIE) endpoint to allow communication through your HIE with other health-care partners. This communication may help improve your HIE measures for the Merit-based Incentive Payment System (MIPS), as well as improve your overall care coordination and referral quality.
- Make sure to click Error Check after all changes are made to ensure that the information provided is complete.
- Click Save and Return to Main Page in the lower right corner. This will activate a dialogue window.
- Click Complete NPI Application to submit all entered changes to NPPES.
- Click Main Page at the top of the menu bar on the left to return to the NPPES main page. From there, you can make further changes or sign out from the upper right corner.
Reminder: NPPES taxonomies MUST be up to date to successfully enroll and revalidate in PEMS. Ensure that taxonomy codes on the NPPES website remain up to date with the available taxonomy codes used to identify applicable program selections in PEMS. Providers with an API still choose a taxonomy, but it will not be compared with NPPES.
PEMS Is an NPI/API-Based System
PEMS bases each enrollment request and maintenance tasks on the NPI or API of the provider that is applying or is enrolled rather than on legacy identifiers, such as a Texas Provider Identifier (TPI). PEMS bases each enrollment application on the applying provider’s NPI or API.
Providers who would like to enroll in Texas health-care programs must do so under one of two categories determined by their NPI information on file with NPPES or API:
An NPI is not required for enrollment for nonhealth-care services. However, the provider must attest that they are not a health-care provider and cannot obtain an NPI to be assigned an API.
Providers that may have an API include but are not limited to:
- Financial management services agencies (FMSAs)
- Community Living Assistance & Support Services (CLASS) – Case management agencies
- Transition assistance services agencies
For more information about who may not apply for an NPI, refer to Title 45 Code of Federal Regulations (CFR) §160.103.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.