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WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

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This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org.

3. U.S. GOVERNMENT RIGHTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements.

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Provider Enrollment and Management System (PEMS) Post-Deployment Update

Last updated on 11/10/2023

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.

Since the deployment of the Provider Enrollment and Management System (PEMS), the Texas Medicaid & Healthcare Partnership (TMHP) has heard from many providers and used their feedback to enhance the provider user experience.

Topic	Current Status
Helpful Tips to Avoid Common Enrollment Deficiencies	Disclosing Principals and Managerial Employees An Owner/Creditor/Principal entry must be completed by each owner, principal, creditor, and subcontractor of the provider that is applying for enrollment. Refer to the Texas Medicaid Provider Procedures Manual (TMPPM), Provider Enrollment and Responsibilities, subsection 1.1.9.3, “Owner/Creditor/Principal Entry,” and ACA Screening Requirements. Tip: Providers must disclose all direct and indirect owners and principals in accordance with the Medicare enrollment record, if applicable. Managerial employees or staff who exercise operational control must have a Principal entry in PEMS. The Office of Inspector General (OIG) will compare the applicant’s organizational structure chart and the list of principals in PEMS. Assumed Name Certificates If the Doing Business As (DBA) name differs from the legal name, an Assumed Name Certificate from the Secretary of State must be submitted. Exception: An Assumed Name Certificate is not required if the provider has listed the tax classification as Disregarded Entity. Tip: Do not include a DBA name on line 2 of the W9 form if it is not a legal DBA that is recognized by the Secretary of State. Each practice location can be given a unique location name that does not have to be recognized as a legal DBA. Application Fees for Different Programs Institutional providers must pay an application fee for initial applications, as well as applications for new practice locations, revalidation, and reenrollment. Providers will be notified of the fee upon completion of the PEMS online application. If the applicant is enrolling with multiple programs and taxonomies, PEMS may require multiple application fees. Government-owned institutions that are prompted to pay an application fee must request a waiver for the application fee requirements. Tip: Separate enrollment with the Managed Care Organization (MCO) Long-term Care Services and Support (LTSS) Program is not required if the National Provider Identifier (NPI) and taxonomy combination is already enrolled in PEMS.

Topic

Current Status

Helpful Tips to Avoid Common Enrollment Deficiencies

Disclosing Principals and Managerial Employees

An Owner/Creditor/Principal entry must be completed by each owner, principal, creditor, and subcontractor of the provider that is applying for enrollment. Refer to the Texas Medicaid Provider Procedures Manual (TMPPM), Provider Enrollment and Responsibilities, subsection 1.1.9.3, “Owner/Creditor/Principal Entry,” and ACA Screening Requirements.

Tip: Providers must disclose all direct and indirect owners and principals in accordance with the Medicare enrollment record, if applicable. Managerial employees or staff who exercise operational control must have a Principal entry in PEMS. The Office of Inspector General (OIG) will compare the applicant’s organizational structure chart and the list of principals in PEMS.

Assumed Name Certificates

If the Doing Business As (DBA) name differs from the legal name, an Assumed Name Certificate from the Secretary of State must be submitted.

Exception: An Assumed Name Certificate is not required if the provider has listed the tax classification as Disregarded Entity.

Tip: Do not include a DBA name on line 2 of the W9 form if it is not a legal DBA that is recognized by the Secretary of State. Each practice location can be given a unique location name that does not have to be recognized as a legal DBA.

Application Fees for Different Programs

Institutional providers must pay an application fee for initial applications, as well as applications for new practice locations, revalidation, and reenrollment. Providers will be notified of the fee upon completion of the PEMS online application. If the applicant is enrolling with multiple programs and taxonomies, PEMS may require multiple application fees.
Government-owned institutions that are prompted to pay an application fee must request a waiver for the application fee requirements.

Tip: Separate enrollment with the Managed Care Organization (MCO) Long-term Care Services and Support (LTSS) Program is not required if the National Provider Identifier (NPI) and taxonomy combination is already enrolled in PEMS.

Topic	Current Status
Key Changes That Have Been Implemented	Display Performing Provider Associated to Group Group practice locations will now display performing providers in the Provider Dashboard in PEMS (when the group is enrolled as both a group and facility). NPI Verification Against NPPES Reminder: Providers must have an active National Provider Identifier (NPI) and meet all provider enrollment criteria to remain active in any Texas state health care program. If TMHP determines that a provider NPI is no longer active in the National Plan and Provider Enumeration System (NPPES), the provider will be disenrolled from all Texas state health care programs. Providers with an inactive NPI accessing PEMS will receive a message that their NPI is inactive. Providers should contact NPPES at 800-465-3203 to research and resolve any issues with their NPI. TMHP will reverify a provider’s NPI status with NPPES when the next NPPES dissemination file is released. Revalidation Requests Providers need to submit revalidation requests prior to the revalidation due date in PEMS. When a draft revalidation request is submitted after the NPI revalidation due date, an error message will display and will prevent submission of the revalidation request. The provider must create and submit a PEMS reenrollment request if the NPI revalidation due date has passed. Additional information related to revalidation in PEMS is available on the TMHP website: Provider Enrollment Frequently Asked Questions (FAQ) Enrollment Revalidation Quick Reference Duplicate Program Check When a user adds a program/practice in PEMS and the program/practice matches another program/practice at the same location, the following message will display, “Unable to save a duplicate program record. Please reenroll the Program record with the same Program and Primary Taxonomy or change the Program and Primary Taxonomy to be different than the other duplicate Program record.” PEMS Enrollment Deficiencies Providers have a total of 45 business days to complete and resolve all deficiencies when completing their enrollment application. PEMS will display the message, “You must respond to and resolve all deficiencies within 45 business days.” Kidney Health Care (KHC) Provider Enrollment KHC requires the user to enter Mailing as Address Type when Social Worker is selected as Contact Type. Users must enter Contact Address as Address Type when Enrollment Contact is selected as Contact Type. This information is required for New Enrollment, Existing Enrollment, Revalidation, Reenrollment, and PEMS Maintenance – Practice Location request types. Physical Address – Practice Location PEMS will only allow physical addresses (not P.O. boxes) to be added as a practice location on the Practice Location Information page and on the Ownership/Controlling/Principal Information page in PEMS. License – Practice Location On the Program and Services Participation Details page, providers now have the option to remove the Licenses/Certifications/Accreditations that are applied to the program practice record. This will end date the license association to the program practice for licenses that have previously been approved and will display the association’s effective dates for the segments as “Removed.” Licenses that have not been approved and that were added by mistake will not have the termination date added. Users can add licenses to the program practice record that were previously removed by selecting Reactivate. This will null the earlier termination date. Physical Therapy/Occupational Therapy Groups The Medicare Program Specific Questions will now display for Physical/Occupational Therapy groups in PEMS. Display Practice Location - Physician Letter of Agreement The performing provider Physician’s Letter of Agreement will display program.

Topic

Current Status

Key Changes That Have Been Implemented

Display Performing Provider Associated to Group

Group practice locations will now display performing providers in the Provider Dashboard in PEMS (when the group is enrolled as both a group and facility).

NPI Verification Against NPPES

Reminder: Providers must have an active National Provider Identifier (NPI) and meet all provider enrollment criteria to remain active in any Texas state health care program. If TMHP determines that a provider NPI is no longer active in the National Plan and Provider Enumeration System (NPPES), the provider will be disenrolled from all Texas state health care programs.

Providers with an inactive NPI accessing PEMS will receive a message that their NPI is inactive.

Providers should contact NPPES at 800-465-3203 to research and resolve any issues with their NPI. TMHP will reverify a provider’s NPI status with NPPES when the next NPPES dissemination file is released.

Revalidation Requests

Providers need to submit revalidation requests prior to the revalidation due date in PEMS. When a draft revalidation request is submitted after the NPI revalidation due date, an error message will display and will prevent submission of the revalidation request. The provider must create and submit a PEMS reenrollment request if the NPI revalidation due date has passed.

Additional information related to revalidation in PEMS is available on the TMHP website:

Duplicate Program Check

When a user adds a program/practice in PEMS and the program/practice matches another program/practice at the same location, the following message will display, “Unable to save a duplicate program record. Please reenroll the Program record with the same Program and Primary Taxonomy or change the Program and Primary Taxonomy to be different than the other duplicate Program record.”

PEMS Enrollment Deficiencies

Providers have a total of 45 business days to complete and resolve all deficiencies when completing their enrollment application. PEMS will display the message, “You must respond to and resolve all deficiencies within 45 business days.”

Kidney Health Care (KHC) Provider Enrollment

KHC requires the user to enter Mailing as Address Type when Social Worker is selected as Contact Type. Users must enter Contact Address as Address Type when Enrollment Contact is selected as Contact Type. This information is required for New Enrollment, Existing Enrollment, Revalidation, Reenrollment, and PEMS Maintenance – Practice Location request types.

Physical Address – Practice Location

PEMS will only allow physical addresses (not P.O. boxes) to be added as a practice location on the Practice Location Information page and on the Ownership/Controlling/Principal Information page in PEMS.

License – Practice Location

On the Program and Services Participation Details page, providers now have the option to remove the Licenses/Certifications/Accreditations that are applied to the program practice record. This will end date the license association to the program practice for licenses that have previously been approved and will display the association’s effective dates for the segments as “Removed.” Licenses that have not been approved and that were added by mistake will not have the termination date added.

Users can add licenses to the program practice record that were previously removed by selecting Reactivate. This will null the earlier termination date.

Physical Therapy/Occupational Therapy Groups

The Medicare Program Specific Questions will now display for Physical/Occupational Therapy groups in PEMS.

Display Practice Location - Physician Letter of Agreement

The performing provider Physician’s Letter of Agreement will display program.

Topic	Current Status
PEMS Portal Reminder	Updating CLIA Certifications in PEMS Providers must update their Clinical Laboratory Improvement Amendment (CLIA) certifications in PEMS under the License/Certification/Accreditation link. Providers may find more information about updating CLIA certifications in PEMS on the Licenses/Certifications/Accreditations page on tmhp.com. Refer to the web article that was posted to tmhp.com on April 7, 2023. Accessing PEMS Providers must have access to the internet to access PEMS, and use up-to-date internet browsers for optimum performance of the PEMS portal. TMHP recommends the use of Google Chrome or Microsoft Edge, as legacy Microsoft browsers Internet Explorer and non-Chromium based Edge are no longer compatible with PEMS.

Topic

Current Status

PEMS Portal Reminder

Updating CLIA Certifications in PEMS

Providers must update their Clinical Laboratory Improvement Amendment (CLIA) certifications in PEMS under the License/Certification/Accreditation link. Providers may find more information about updating CLIA certifications in PEMS on the Licenses/Certifications/Accreditations page on tmhp.com.

Refer to the web article that was posted to tmhp.com on April 7, 2023.

Accessing PEMS

Providers must have access to the internet to access PEMS, and use up-to-date internet browsers for optimum performance of the PEMS portal. TMHP recommends the use of Google Chrome or Microsoft Edge, as legacy Microsoft browsers Internet Explorer and non-Chromium based Edge are no longer compatible with PEMS.

Topic	Current Status
Claims by First-time Enrolling Providers	Newly enrolled providers may refer to the current Texas Medicaid Provider Procedures Manual, Section 6, “Claims Filing,” for more information regarding enrollment and claims filing.

Topic	Current Status
PEMS Instructional YouTube Videos	TMHP has developed a series of instructional how-to videos that detail the steps required to update provider enrollment records. To view the completed series of instructional how-to videos, visit the Provider Enrollment Help page on tmhp.com.

Topic

Current Status

PEMS Instructional YouTube Videos

TMHP has developed a series of instructional how-to videos that detail the steps required to update provider enrollment records.

To view the completed series of instructional how-to videos, visit the Provider Enrollment Help page on tmhp.com.

Topic	Current Status
PEMS Multi-Factor Authentication for Electronic Funds Transfer (EFT) Updates	Effective June 30, 2023, additional verification is required when EFT (electronic fund transfer) information has been updated on the following PEMS request types: Reenrollment, Revalidation, and Existing Enrollment. A personal identification number (PIN) sent to the email address on file will be needed to make any changes to EFT information. As a reminder, providers needing to update their email addresses must submit a "Maintenance-Provider Information-Change Email" request to ensure that PEMS has the latest information. Providers may also submit this request if they need to update their email while the request for EFT changes is in flight. Previous posting from March 21, 2023: Effective April 15, 2023, additional verification is required for PEMS EFT (electronic fund transfer) changes. A personal identification number (PIN) sent to the email address on file will be needed to make any changes to EFT information. EFT change requests cannot be created within 30 calendar days after approval of a “Maintenance-Provider Information-Change Email” request.

Topic

Current Status

PEMS Multi-Factor Authentication for Electronic Funds Transfer (EFT) Updates

Effective June 30, 2023, additional verification is required when EFT (electronic fund transfer) information has been updated on the following PEMS request types: Reenrollment, Revalidation, and Existing Enrollment. A personal identification number (PIN) sent to the email address on file will be needed to make any changes to EFT information.

As a reminder, providers needing to update their email addresses must submit a "Maintenance-Provider Information-Change Email" request to ensure that PEMS has the latest information. Providers may also submit this request if they need to update their email while the request for EFT changes is in flight.

Previous posting from March 21, 2023:

Effective April 15, 2023, additional verification is required for PEMS EFT (electronic fund transfer) changes. A personal identification number (PIN) sent to the email address on file will be needed to make any changes to EFT information. EFT change requests cannot be created within 30 calendar days after approval of a “Maintenance-Provider Information-Change Email” request.

View previous postings below:

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