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Provider Enrollment and Management System (PEMS) Post-Deployment Update

Last updated on 8/15/2022

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 thirteenth 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

 

Kidney Health Care (KHC) and Children with Special Health Care Needs – Family Support Services (CSHCN-FSS) program providers will be able to enroll in TMHP PEMS on August 15, 2022.

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 – Transplant
  • 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

Revalidation

The Texas Health and Human Services Commission (HHSC) is reinstating the flexibility that extended revalidation dates due to the COVID-19 public health emergency (PHE).

Refer to the web article that was posted to tmhp.com on August 3, 2022.

Topic

Current Status

Key Changes That Have Been Implemented

 

Added Paging Functionality to Services Provided Page and Practice Location Information Page:

  • The Services Provided page and Practice Location Information page Billing Practice Locations tab will display at the top and bottom of the pages with a Previous and Next button when there are more than 50 records.

Medicare Fields Being Editable for Providers:

  • Providers can now edit the Medicare Effective Date and Medicare Number in the Program Specific Questions section of the Program and Service Participation Details page.

Deleting Accounting/Billing Information:

  • Providers can now delete records on the Account/Billing information page. PEMS will not allow a record to be deleted if the Accounting/Billing record is historical information that has been converted into PEMS.

Clinical Laboratory Improvement Amendments (CLIA):

  • PEMS has been updated to require the CLIA Certification Type when a CLIA certification is added to the Licenses/
    Certifications/Accreditations page. The CLIA type must be selected from the drop-down menu for the LAB CERTIFICATION (CODE) field within the CLIA Type(s) and Laboratory Certification(s) section.

Business and System Deficiency Statuses:

  • All business and system deficiencies in all statuses are now displaying.

Topic

Current Status

Future Implementation

 

New PEMS Request Type Maintenance – Practice Location – Surety Bond Is Being Created:

  • Providers are no longer required to submit surety bond updates through an Existing Enrollment Request type. A new PEMS Maintenance Request Type will be created for surety bond updates to allow the providers to submit surety bond updates via a Maintenance Request.

New Surety Bond functionality will be available on August 15, 2022.

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.

TMHP is working on adding paging to this page.

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 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 - YouTube

Don’t forget to submit your request after adding or updating any information.

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.

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 by provider type.

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 National Provider Identifier (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 on 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

 

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.