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.
Reminder: Effective May 12, 2023, providers that do not complete the revalidation process by their deadline will be disenrolled from all Texas state health care programs, and claims and prior authorization requests will be denied. Additional information about this change is available in the web article that was posted to tmhp.com on March 10, 2023.
Locating Revalidation Due Dates
Providers can find their revalidation due dates on the Provider Information page in the Provider Enrollment and Management System (PEMS). Additionally, providers should ensure any email addresses on file are up to date and approved in order to receive the revalidation reminder notifications through email. Providers with valid email addresses on file will receive reminder notices at the 120-, 90-, and 45-day mark prior to their revalidation due date. Providers can access the PEMS-associated job aid, Verifying an Email in PEMS, on tmhp.com if they need help confirming their email address.
Submitting Revalidation Requests
Providers must submit revalidation requests before the revalidation due date in PEMS. When a draft revalidation request is submitted after the National Provider Identifier (NPI) revalidation due date, an error message will display and prevent the revalidation request’s submission. The provider must create and submit a PEMS reenrollment request if the NPI revalidation due date has passed.
If the revalidation application is not completed by the revalidation due date, a payment hold will be applied to the enrollment (effective on the revalidation due date) until the revalidation application is closed. If the application is completed within 45 days of the revalidation due date, there will not be an enrollment gap, and the provider can be reimbursed for the services rendered during the application processing.
Providers revalidating an existing enrollment should continue to submit claims to meet their timely filing requirements.
Taxonomies must be on file and up to date in the National Plan and Provider Enumeration System (NPPES) for providers to successfully enroll and revalidate enrollment in PEMS. Providers must ensure that their taxonomy codes on the NPPES website remain up to date and accurate for the appropriate programs and service types in PEMS.
Additional information related to revalidation in PEMS is available on the TMHP website:
- Taxonomies Must Be on File with NPPES to Enroll and Revalidate in PEMS
- Reminder: Provider Enrollment Revalidation Requirements
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.