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.
Effective June 13, 2023, Texas Medicaid & Healthcare Partnership (TMHP) requires providers to review and update their practice addresses in the Provider Enrollment and Management System (PEMS).
If the provider performs services at locations other than those listed in PEMS, the provider must take action to add those addresses to their enrollment record.
For nonperforming providers with practice locations that require an address correction, submit a Maintenance - Practice Location – Address Change request. For practice locations that are currently not enrolled, submit an Existing Enrollment request.
For performing providers with practice locations that are currently not enrolled, submit either a Maintenance - Add/Modify Performing Provider request or Existing Enrollment request.
Refer to the Maintenance tab on the PEMS Instructional Site for more information on updating provider addresses in PEMS.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.