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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), 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 twentieth edition of this list, following the first edition that was posted on February 28, 2022.

Topic

Current Status

PEMS Portal Reminder

Accessing PEMS:

Providers must have access to the internet to utilize PEMS and use up-to-date internet browsers for optimum performance of the PEMS portal. TMHP recommends the use of Google Chrome or Microsoft Edge because legacy Microsoft browsers Internet Explorer and non-Chromium based Edge are no longer compatible with PEMS.

Topic

Current Status

Key Changes That Have Been Implemented

 

New PEMS Maintenance Functionality for Performing Providers Has Been Added:

  • 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.

Refer to the web article that was posted to tmhp.com on November 11, 2022.

New Error Message “License set to Expire” Has Been Created:

  • The newly added error message will let providers know to visit the License/ Certifications/Accreditations page and update any license expiration date due to expire in 30 days.

Updated the License Issuer for the Following Provider Types:

  • Audiologist – updated State Board of Examiners for Speech-Language Pathology and Audiology TO Texas Department of Licensing and Regulation (TDLR) – Acute Care Fee for Service, Children’s Health Insurance Program (CHIP), Children with Special Health Care Needs (CSHCN) Services Program for individual and performing providers.
  • Hearing Aid – updated State Committee of Examiners in the Fitting and Dispensing of Hearing Instruments TO TDLR.
  • Podiatrist – updated Texas State Board of Podiatric Medical Examiners TO TDLR.
  • Dietician – updated Texas State Board of Examiners of Dietitians TO TDLR.
  • Licensed Midwife – updated Texas Midwifery Board TO TDLR.
  • Licensed Orthotist – updated Texas Board of Orthotics and Prosthetics TO TDLR.
  • Prosthetist – updated Texas Board of Orthotics and Prosthetics TO TDLR.
  • Speech Language Pathologist – updated State Board of Examiners for Speech-Language Pathology and Audiology TO TDLR.

New PEMS Request Type ‘Maintenance – Practice Location – Surety Bond’ Has Been Created:

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

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 be displayed at the top and bottom of the pages with a Previous and Next button when there are more than 50 records.

Medicare Fields Now 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

Enrollment Effective Date

The policy for Medicaid-enrollment effective dates will allow the retroactive enrollment date to be the same as the Medicare certification date for providers that have the same Medicare and Medicaid risk category.

PEMS will calculate the program effective date based on the following criteria:

  1. For the Vendor Drug Program, the program effective date will be populated the same as the approval date.
  2. For Medicare-enrolled programs with a default screen risk, the program effective date will be the same as the latest of the dates (closest to current date) in the following bullets.
    • 1 year prior to the application submission date.
    • License issue date (if there is more than one license issue date, then the latest license issue date will be used).
    • Medicare certification date (if there is more than one Medicare certification date, then the earliest Medicare certification date will be used).
    • Change of ownership (CHOW) effective date.
  3. For Medicare-enrolled programs with an elevated screen risk, the program effective date will be the same as the approval date.
  4. For Medicaid-only (non-Medicare-enrolled) programs with a default screen risk, the program effective date will be the same as the application submission date.
  5. For Medicaid-only (non-Medicare-enrolled) programs with an elevated screen risk, the program effective date will be the same as the approval date.
  6. For Medicare-enrolled programs with a default screen risk and Medicare effective date is a future date, the program effective date will be the same as the Medicare effective date (i.e., future date).

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 are now able to enroll in TMHP PEMS effective August 15, 2022.

Refer to the updated web article that was posted to tmhp.com on September 6, 2022.

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

New Practice Location Page Features

TMHP is implementing changes to enhance user experience in PEMS. A new tab titled “Performing Providers” will be displayed on 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 per 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 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

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.