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), the 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 twelfth edition of this list, following the first edition that was posted on February 28, 2022.
Topic |
Current Status |
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Key Changes That Have Been Implemented
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Medicare Fields Being Editable for Providers:
Deleting Accounting/Billing Information:
Clinical Laboratory Improvement Amendments (CLIA):
Business and System Deficiency Statuses:
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Topic |
Current Status |
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Future Implementation
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New PEMS Request Type “Maintenance – Practice Location – Surety Bond” Is Being Created:
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Topic |
Current Status |
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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. TMHP is working on adding paging to this page. |
Topic |
Current Status |
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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’re not sure how to attach the required additional documentation, visit TMHP’s YouTube channel and watch one of the newest how-to videos: Don’t forget to submit your request after adding or updating any information. Troubleshooting:
Submitting License Information: License submission rules have been implemented where you are required to submit your license information prior to submitting the application. Licenses vary per provider type. |
Topic |
Current Status |
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Kidney Health Care (KHC) and Children with Special Health Care Needs – Family Support Services (CSHCN-FSS) Texas Medicaid Enrollment Status
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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 PEMS. 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 (MD/DO) · Prescription Drug Program · Renal Dialysis Facility (Freestanding) · Renal Dialysis Facility (Hospital Based) CSHCN-FSS Providers: · Respite Care · Home Modifications · Home Inspectors · Vehicle Modifications |
Topic |
Current Status |
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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 revalidation due date. In some cases, TMHP has adjusted the revalidation due date for a provider [based on the 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 |
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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:
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 |
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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:
- February 28, 2022
- March 11, 2022
- March 29, 2022
- April 11, 2022
- April 25, 2022
- May 9, 2022
- May 23, 2022
- June 2, 2022
- June 20, 2022
- July 1, 2022
- July 18, 2022
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.