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Updates to PEMS for Performing Provider Revalidations Effective August 25, 2023

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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.

Effective August 25, 2023, administrators of a group National Provider Identifier (NPI) can submit group-initiated revalidation requests in the Provider Enrollment and Management System (PEMS) for performing providers that are participating in more than one group.

Because of this update, performing providers no longer must submit their own revalidations. In addition, PEMS business rules will also be updated to include locations and program/practice records for other groups.

Note: For detailed instructions on group-initiated performing provider revalidations, refer to the PEMS Instructional Site.

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