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WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

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This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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

Last updated on 5/16/2023

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’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 twenty-eighth edition of this list, following the first edition that was posted on February 28, 2022.

Topic	Current Status
Revalidation	Per the COVID-19 public health emergency (PHE), Texas Medicaid had extended the dates to complete the provider enrollment revalidation process. Effective May 11, 2023, the federal flexibility to extend Medicaid provider revalidation dates that were due during the federal COVID-19 PHE will end. TMHP has sent an email to affected providers with a recalculated revalidation due date. Providers can find their revalidation due dates in the Provider Dashboard in PEMS under the Revalidation Due Date field in the Enrollment Information section of the Provider Information page. Refer to the web article that was posted to tmhp.com on March 10, 2023.

Topic

Current Status

Revalidation

Per the COVID-19 public health emergency (PHE), Texas Medicaid had extended the dates to complete the provider enrollment revalidation process.

Effective May 11, 2023, the federal flexibility to extend Medicaid provider revalidation dates that were due during the federal COVID-19 PHE will end. TMHP has sent an email to affected providers with a recalculated revalidation due date.

Providers can find their revalidation due dates in the Provider Dashboard in PEMS under the Revalidation Due Date field in the Enrollment Information section of the Provider Information page.

Refer to the web article that was posted to tmhp.com on March 10, 2023.

Topic	Current Status
PEMS Portal Reminder	Updating CLIA Certifications in PEMS Providers must update their Clinical Laboratory Improvement Amendment (CLIA) certifications in PEMS under the License/Certification/Accreditation link. Providers may find more information about updating CLIA certifications in PEMS on the Licenses/Certifications/Accreditations page on tmhp.com. Refer to the web article that was posted to tmhp.com on April 7, 2023. Accessing PEMS Providers must have access to the internet to access 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, as legacy Microsoft browsers Internet Explorer and non-Chromium based Edge are no longer compatible with PEMS.

Topic

Current Status

PEMS Portal Reminder

Updating CLIA Certifications in PEMS

Providers must update their Clinical Laboratory Improvement Amendment (CLIA) certifications in PEMS under the License/Certification/Accreditation link. Providers may find more information about updating CLIA certifications in PEMS on the Licenses/Certifications/Accreditations page on tmhp.com.

Refer to the web article that was posted to tmhp.com on April 7, 2023.

Accessing PEMS

Providers must have access to the internet to access 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, as 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	Duplicate Program Check When a user adds a program/practice in PEMS and the program/practice matches another program/practice at the same location, the following message will display: “Unable to save a duplicate program record. Please reenroll the Program record with the same Program and Primary Taxonomy or change the Program and Primary Taxonomy to be different than the other duplicate Program record.” PEMS Enrollment Deficiencies Providers have a total of 45 business days to complete and resolve all deficiencies when completing their enrollment application. PEMS will display the message “You must respond to and resolve all deficiencies within 45 business days.” Kidney Health Care (KHC) Provider Enrollment KHC requires the user to enter Mailing as Address Type when Social Worker is selected as Contact Type. Users must enter Contact Address as Address Type when Enrollment Contact is selected as Contact Type. This information is required for New Enrollment, Existing Enrollment, Revalidation, Reenrollment, and PEMS Maintenance – Practice Location request types. Physical Address – Practice Location PEMS will only allow physical addresses (not P.O. boxes) to be added as a practice location on the Practice Location Information page and on the Ownership/Controlling/Principal Information page in PEMS. License – Practice Location On the Program and Services Participation Details page, providers now have the option to remove the Licenses/Certifications/Accreditations that are applied to the program practice record. This will end date the license association to the program practice for licenses that have previously been approved and will display the association’s effective dates for the segments as “Removed.” Licenses that have not been approved and that were added by mistake will not have the termination date added. Users can add licenses to the program practice record that were previously removed by selecting Reactivate. This will null the earlier termination date. Revalidation Requests Providers need to submit revalidation requests prior to the revalidation due date in PEMS. When a draft revalidation request is submitted after the NPI revalidation due date, an error message will display and will prevent submission of the revalidation request. The provider must create and submit a PEMS reenrollment request if the NPI revalidation due date has passed. Additional information related to revalidation in PEMS is available on the TMHP website: Provider Enrollment Frequently Asked Questions (FAQ) Physical Therapy/Occupational Therapy Groups The Medicare Program Specific Questions will now display for Physical/Occupational Therapy groups in PEMS. Display Practice Location - Physician Letter of Agreement The performing provider Physician’s Letter of Agreement will display program. Provider Enrollment (PE) License Renewal in Process Letter for LTC Provider Types PE and Site Visit (SV) will now accept the License Renewal In Process Letter for provider types that receive licenses from Health and Human Services Commission Long-term Care (HHSC-LTC) with licenses that are expired or approaching expiration while their reenrollment or revalidation is in process. The following provider types are included: Home & Community Support Services Agencies (Home Health & HCSSA); Assisted Living Facilities (ALFs); Day Activity and Health Services Facilities (DAHS); Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID); Skilled Nursing & Nursing Facilities (SNF/NF); Personal Assistance Services (PAS/PCS); Prescribed Pediatric Extended Care Centers (PPECC); Primary Home Care (PHC)/Family Care (FC)/Community Attendant Services (CAS); Program of All-Inclusive Care for the Elderly (PACE). Maintenance – Add/Modify Performing Provider Request If the performing provider program practice location that is selected from the “Select the Existing Program to Add” drop-down menu is enrolled in Medicare, the request will only allow the provider to select the group program locations related to the same Medicare association. System Performance and Deficiency Improvements TMHP continues to improve the user experience with system performance and deficiency updates throughout PEMS. The most recent deficiency updates include enhancements to the following sections in PEMS: Programs, Ownership/Controlling Interest, and Practice Location Information. Error Message for Duplicate Enrollment PEMS will display the error message “Unable to create the request” when there is a duplicate enrollment request for the same performing provider.

Topic

Current Status

Key Changes That Have Been Implemented

Duplicate Program Check

When a user adds a program/practice in PEMS and the program/practice matches another program/practice at the same location, the following message will display: “Unable to save a duplicate program record. Please reenroll the Program record with the same Program and Primary Taxonomy or change the Program and Primary Taxonomy to be different than the other duplicate Program record.”

PEMS Enrollment Deficiencies

Providers have a total of 45 business days to complete and resolve all deficiencies when completing their enrollment application. PEMS will display the message “You must respond to and resolve all deficiencies within 45 business days.”

Kidney Health Care (KHC) Provider Enrollment

KHC requires the user to enter Mailing as Address Type when Social Worker is selected as Contact Type. Users must enter Contact Address as Address Type when Enrollment Contact is selected as Contact Type. This information is required for New Enrollment, Existing Enrollment, Revalidation, Reenrollment, and PEMS Maintenance – Practice Location request types.

Physical Address – Practice Location

PEMS will only allow physical addresses (not P.O. boxes) to be added as a practice location on the Practice Location Information page and on the Ownership/Controlling/Principal Information page in PEMS.

License – Practice Location

On the Program and Services Participation Details page, providers now have the option to remove the Licenses/Certifications/Accreditations that are applied to the program practice record. This will end date the license association to the program practice for licenses that have previously been approved and will display the association’s effective dates for the segments as “Removed.” Licenses that have not been approved and that were added by mistake will not have the termination date added.

Users can add licenses to the program practice record that were previously removed by selecting Reactivate. This will null the earlier termination date.

Revalidation Requests

Providers need to submit revalidation requests prior to the revalidation due date in PEMS. When a draft revalidation request is submitted after the NPI revalidation due date, an error message will display and will prevent submission of the revalidation request. The provider must create and submit a PEMS reenrollment request if the NPI revalidation due date has passed.

Additional information related to revalidation in PEMS is available on the TMHP website:

Provider Enrollment Frequently Asked Questions (FAQ)

Physical Therapy/Occupational Therapy Groups

The Medicare Program Specific Questions will now display for Physical/Occupational Therapy groups in PEMS.

Display Practice Location - Physician Letter of Agreement

The performing provider Physician’s Letter of Agreement will display program.

Provider Enrollment (PE) License Renewal in Process Letter for LTC Provider Types

PE and Site Visit (SV) will now accept the License Renewal In Process Letter for provider types that receive licenses from Health and Human Services Commission Long-term Care (HHSC-LTC) with licenses that are expired or approaching expiration while their reenrollment or revalidation is in process.

The following provider types are included: Home & Community Support Services Agencies (Home Health & HCSSA); Assisted Living Facilities (ALFs); Day Activity and Health Services Facilities (DAHS); Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID); Skilled Nursing & Nursing Facilities (SNF/NF); Personal Assistance Services (PAS/PCS); Prescribed Pediatric Extended Care Centers (PPECC); Primary Home Care (PHC)/Family Care (FC)/Community Attendant Services (CAS); Program of All-Inclusive Care for the Elderly (PACE).

Maintenance – Add/Modify Performing Provider Request

If the performing provider program practice location that is selected from the “Select the Existing Program to Add” drop-down menu is enrolled in Medicare, the request will only allow the provider to select the group program locations related to the same Medicare association.

System Performance and Deficiency Improvements

TMHP continues to improve the user experience with system performance and deficiency updates throughout PEMS. The most recent deficiency updates include enhancements to the following sections in PEMS: Programs, Ownership/Controlling Interest, and Practice Location Information.

Error Message for Duplicate Enrollment

PEMS will display the error message “Unable to create the request” when there is a duplicate enrollment request for the same performing provider.

Topic	Current Status
Claims by First-time Enrolling Providers	Newly enrolled providers may refer to the current Texas Medicaid Provider Procedures Manual, Section 6, “Claims Filing,” for more information regarding enrollment and claims filing.

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, visit the Provider Enrollment Help page on tmhp.com.

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, visit the Provider Enrollment Help page on tmhp.com.

Topic	Current Status
PEMS Multi-Factor Authentication for Electronic Funds Transfer (EFT) Updates	Effective April 15, 2023, additional verification is required for PEMS EFT (electronic fund transfer) changes. A personal identification number (PIN) sent to the email address on file will be needed to make any changes to EFT information. EFT change requests cannot be created within 30 calendar days after approval of a “Maintenance-Provider Information-Change Email” request.

View previous postings below:

February 28, 2022

March 11, 2022

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