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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, pre-certification, 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.
In response to the COVID-19 public health emergency (PHE) and in alignment with federal guidelines, the Texas Health and Human Services Commission (HHSC) allowed Medicaid providers to delay their provider enrollment revalidation requirements. To accommodate this flexibility, the Texas Medicaid & Healthcare Partnership (TMHP) extended revalidation due dates between March 1, 2020, through May 11, 2023, for Medicaid providers.
Effective May 11, 2023, the HHSC will end the flexibility of extended Medicaid provider enrollment revalidation dates that were implemented during the COVID-19 PHE.
Per federal guidance, providers that were due for revalidation effective March 1, 2020, through May 11, 2023, will receive a post-PHE grace period to complete the revalidation process. TMHP will notify providers in March 2023 of their recalculated Medicaid enrollment end date and again 120 days prior to their end date.
Providers are strongly encouraged to avoid potential enrollment delays by submitting revalidation applications as soon as possible within the 120-day window.
Providers may find more information and start their revalidations in the Provider Enrollment and Management System (PEMS) 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, and all claims and prior authorization requests submitted after the revalidation deadline will be denied.
Provider Enrollment Revalidation Requirements
Revalidating providers may need to provide fingerprints, submit additional documentation, or complete other screening requirements.
Providers can visit PEMS to view and confirm their revalidation date and enrollment information. To speed up the application process, providers should 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 that are revalidating an existing enrollment should continue to submit claims to meet their timely filing requirements while their revalidation is being processed.
Certain revalidating providers must pay a provider enrollment application fee. Refer to the State of Texas Provider Types Required to Pay an Application Fee for a list of institutional providers that have to pay the application fee.
Providers can also refer to the current Texas Medicaid Provider Procedures Manual, Section 1, “Provider Enrollment and Responsibilities,” for more information.
For further assistance, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.