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: The Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS) became operational on December 13, 2021.
Provider enrollment functions are available through PEMS, and providers must use this system to enroll in Texas Medicaid.
How to Enroll in Texas Medicaid
Effective December 13, 2021, enrollment in Texas Medicaid is now done through PEMS:
- PEMS has replaced Provider Enrollment on the Portal (PEP) and the Provider Information Management System (PIMS). PEP and PIMS are no longer available.
- Paper applications for Texas Medicaid provider enrollment have been eliminated.
- Providers must have access to the internet to utilize PEMS and use up-to-date internet browsers for optimum performance of the PEMS portal. Use Google Chrome or Microsoft Edge to reduce compatibility issues.
- Go to the TMHP Provider Enrollment web page to begin your online enrollment.
Texas Medicaid and Other Programs and Services Enrollment Types
Texas Medicaid enrollment in the following programs and services is available through PEMS:
- Acute Care Services
- Comprehensive Care Program (CCP)
- Texas Health Steps Dental
- Texas Health Steps Medical
- Healthy Texas Women (HTW)
- Case Management
- Texas Health and Human Services Commission (HHSC) Long-term Care (LTC)
- Managed Care Organizations – Long-term Services and Supports (MCO-LTSS)
- Pharmacy Services
- Medical Transportation Program (MTP)
- Kidney Health Care (KHC)
- Children with Special Health Care Needs (CSHCN) Services Program
- CSHCN Family Support Services (FSS)
- Children’s Health Insurance Program (CHIP)
How to Create and Manage a TMHP User Account
After creating a TMHP user account, follow these best practices for account management:
- Assign at least two administrators.
- Update user permissions as staff changes occur.
- Look for reminders for upcoming enrollment tasks on the Message Dashboard.
Provider Identification and PEMS
PEMS access is tied to the National Provider Identifier (NPI) or Atypical Provider Identifier (API) associated with the TMHP user account. Providers must ensure that their NPI or API has all their current and correct information.
Important: PEMS bases each enrollment only on the applying provider’s NPI or API. Providers will no longer need legacy identifiers such as the Texas Provider Identifier (TPI), which are not accepted by PEMS.
Providers that would like to enroll in Texas health care programs must do so under one of two categories determined by their NPI information on file with NPPES or their API: Individual or Organization.
An NPI is not required for enrollment for nonhealth care services. However, the provider must attest that they are not a health care provider and cannot obtain an NPI to be assigned an API.
Some examples of providers that may have an API include the following:
- Financial management services agencies (FMSAs)
- Community Living Assistance & Support Services (CLASS) – case management agencies
- Transition assistance services agencies
For more information about who may not apply for an NPI, refer to Title 45 Code of Federal Regulations (CFR) §160.103.
Preparing to Enroll
Before accessing PEMS, providers need to verify that they have the following required information:
- 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 required documentation for program participation
Refer to the checklists on the PEMS Instructional Site for a detailed list of documents and information required to complete applications.
Get PEMS Training Materials on the TMHP Learning Management System (LMS)
- PEMS webinar recordings
- Provider Frequently Asked Questions (FAQ) about PEMS
- The following computer-based training (CBT) modules:
- “General Information”
- “New Enrollment”
- “Provider Management”
- PEMS Video Series
- Video titled “PEMS vs. PEP” (PEP, or Provider Enrollment on the Portal, is the previous system for online provider enrollment. It is no longer in use.)
- “Quick Start Guide to Using PEMS”
- “PEMS Best Practices Guide”
Note: Providers must have an LMS account to access the above materials. To create an LMS account, access the Learning Management System (LMS) Registration and Navigation Job Aid for Providers.
How to Attest Your NPI Taxonomies
The Centers for Medicare & Medicaid Services (CMS) assigns NPIs to clinicians through the National Plan and Enumeration System (NPPES). NPIs are used to track health care providers for billing and quality reporting.
HHSC requires all providers with Medicaid enrollment to ensure that all taxonomies used to bill for Medicaid services are attested to their NPI. Follow these directions for updating provider taxonomy information in NPPES:
- Log in to your NPPES provider account.
- Review the taxonomies selected (attested) for the NPI.
- Sign in using your CMS Identity and Access login credentials.
- Scroll down to “Manage Provider Information.”
- In the “Action” column, click on the pencil icon to open the provider information editor.
- Make any required changes to the individual categories.
- Enter a Health Information Exchange (HIE) endpoint to allow communication through your HIE with other health care partners. (This communication may help improve your HIE measures for the Merit-based Incentive Payment System (MIPS), as well as improve your overall care coordination and referral quality.)
- Click Error Check after all changes have been made to ensure that the information provided is complete.
- Click Save and Return to Main Page in the lower right corner. This will activate a dialogue window.
- Choose Complete NPI Application to submit all entered changes to the NPPES.
- Click Main Page at the top of the menu bar on the left to return to the NPPES main page. From here, you can make further changes or sign out from the upper right corner.
Reminder: NPPES taxonomies MUST be up to date to successfully enroll and revalidate in PEMS. Ensure that the taxonomy codes on the NPPES website remain up to date with the available taxonomy codes used to identify applicable program selections in PEMS. Providers with an API still choose a taxonomy, but it will not be compared with NPPES information.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.