Skip to main content

You must have JavaScript enabled in order to access this part of the site. Please enable JavaScript and then reload this page in order to continue.

New PEMS Maintenance Functionality for Performing Providers

Last updated on

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.

Effective November 1, 2022, the process for enrolling performing providers in multiple group locations has been streamlined to allow group administrators to add performing providers to group practice locations via the Provider Enrollment and Management System (PEMS) Maintenance – Add/Modify Performing Provider functionality.

To complete this streamlined action, navigate to the Performing Providers record and click the Edit Enrollment button in the top right of the screen. From there, select PEMS Maintenance – Add/Modify Performing Provider.

Upon initiating a PEMS Maintenance – Add/Modify Performing Provider request, the administrator will need to add the services provided (taxonomy) and program selections. PEMS will display the locations where services are provided based on the group practice locations that the performing provider is eligible to select.

There are some key considerations in using this new request form:

  • Group administrators will complete this action for each performing provider.
  • The group must have the appropriate programs on file for each location being added [i.e., Acute Care, the Children with Special Health Care Needs (CSHCN) Services Program, etc.]
  • This option will be available only for providers with limited screen risk (moderate- and high-risk providers will continue to use Existing Enrollment.)
  • If a performing provider does not have a taxonomy/program combination on file for the group, this option is not available.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.