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High Risk Providers Must Use the Existing Enrollment Option in PEMS When Adding New Owners

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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.

Enrolled providers designated as the highest (high risk) screen risk category must add owners using the Existing Enrollment option for new enrollments. The Provider Enrollment and Management System (PEMS) Add Owner/Creditor Principal function within a PEMS Maintenance – Ownership/Controlling Interest request is not available for high risk providers.

Refer to the PEMS Instructional Site for additional information about enrollment.

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