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Reminder: Provider Enrollment Revalidation Requirements

Last updated on 9/21/2022

Reminder: Providers must complete their revalidation enrollment before the end of their enrollment period. Providers can revalidate their enrollment in the Provider Enrollment and Management System (PEMS) up to 120 calendar days before their current revalidation due date.

Providers may find more information and start their revalidations in PEMS through the TMHP.com website at https://www.tmhp.com/topics/provider-enrollment/how-apply-enrollment under “Determine Your Application Type.”

Providers that do not complete the revalidation process by their deadline will be disenrolled from all Texas state health care programs. Claims and prior authorization requests will be denied.

Public Health Emergency (PHE) Revalidation Waiver

Current revalidation due dates are being waived until further notice. Email notifications are being sent with the recalculated due date. Providers can view revalidation due dates in PEMS in the Revalidation Due Date field on the Provider Information page in the Enrollment Information section.

Providers that receive a recalculated due date during the public health emergency (PHE) will be eligible to submit revalidations through PEMS 120 days prior to the recalculated due date.

Providers that have submitted revalidation applications and received a recalculated post-PHE due date will be notified via email at the end of the PHE if the next revalidation due date is being recalculated to align with federal Affordable Care Act (ACA) requirements.

Provider Requirements

Revalidating providers may need to provide fingerprints, submit additional documentation, or complete other screening requirements.

Providers may view and confirm their revalidation date and enrollment information in PEMS. To reduce application time, we encourage providers to have the following information available:

  • First and last name
  • Organization name
  • Social Security number
  • Date of birth
  • Employer’s Tax Identification Number and legal name
  • 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 documentation required for program participation

Providers revalidating an existing enrollment should continue to submit claims to meet their timely filing requirements.

Certain revalidating providers must pay an application fee. Refer to the State of Texas Application Fee Requirement by Provider Service to determine which institutional providers must pay the provider enrollment application fee.

Providers can also refer to the current Texas Medicaid Provider Procedures Manual, General Information, Vol. 1, “Provider Enrollment and Responsibilities,” for more information.

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