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

Topic

Current Status

Kidney Health Care (KHC) and Children with Special Health Care Needs – Family Support Services (CSHCN-FSS) Texas Medicaid Enrollment Status

 

 

Providers will soon be able to enroll in the Kidney Health Care (KHC) and Children with Special Health Care Needs – Family Support Services (CSHCN-FSS) programs through TMHP. We’ll post another notice to inform providers when enrollment will be available.

For now, providers should continue to reach out directly to these programs to enroll.

TMHP will enroll the following provider types for these programs:

KHC Providers:

  • Ambulatory Surgical Center (ASC)
  • Certified Registered Nurse
  • Clinic/Group Practice
  • Hospital – In State
  • Hospital – Out of State
  • Hospital – Military
  • Hospital Ambulatory Surgical Center (HASC)
  • Physician (Medical Doctor [MD)]/ Doctor of Osteopathy [DO])
  • Prescription Drug
  • Renal Dialysis Facility (Freestanding)
  • Renal Dialysis Facility (Hospital Based)

CSHCN-FSS Providers:

  • Respite Care
  • Home Modifications
  • Home Inspectors
  • Vehicle Modifications

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.

In some cases, TMHP has adjusted the revalidation due date for a provider’s National Provider Identifier (NPI) who may currently be experiencing PEMS technical issues. Providers who have received an adjusted revalidation due date will be sent an email from TMHP to the administrator of the NPI account. The most up-to-date revalidation due date is reflected in PEMS at all times.

Additionally, all enrollment gaps will be closed for providers who submit timely revalidation applications until August 31, 2022.

Providers may find more information on the Provider Enrollment web page under “Determine Your Application Type” and can start their revalidation in PEMS.

Topic

Current Status

New Practice Location Page Features

 

TMHP is implementing changes to enhance user experience in PEMS. A new tab titled “Performing Providers” will display in the Practice Location Information page. Users will no longer scroll to the bottom of the page to find performing providers for their practice locations.

Topic

Current Status

 

Eligible and Enrolled Taxonomies

 

 

 

TMHP is providing the following information to clarify the difference between eligible and enrolled taxonomies for Texas Medicaid. There is a small but important difference between eligible and enrolled taxonomies:

  • An eligible taxonomy is a taxonomy that is on file with the National Plan and Provider Enumeration System (NPPES) for a given NPI and is eligible for enrollment in Texas Medicaid.
  • An enrolled taxonomy is a taxonomy that is currently enrolled in Texas Medicaid and may be used to submit claims. Providers must use the taxonomy that they have enrolled with for billing purposes. If providers do not use an enrolled taxonomy for claims, they will not receive reimbursement.

The YouTube video “Taxonomies and Enrollment” provides step-by-step instructions as to where providers can find these different types of taxonomies.

To view the completed series of PEMS instructional how-to videos on the TMHP YouTube channel, click here.

Topic

Current Status

Helpful Tips to Reduce Enrollment Application Deficiencies

Check Your Information:

The name on your professional license, your practice location, your 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 your organization is a corporation, limited liability company (LLC), or partnership, be sure to upload the appropriate tax documentation.

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: "Adding Attachments."

Troubleshooting:

  • If the email to sign the Electronic Funds Transfer (EFT) Agreement is not received, this is usually because information may be missing from the Practice Location tab or the Accounting/Billing Information tab. Be sure to double check both tabs for any missing information.

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.