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Providers That Have Not Completed the Revalidation Process By Their Deadline Will Be Disenrolled

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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.

Providers must complete their revalidation enrollment before the end of their enrollment period. Providers that have not completed the revalidation process by their deadline will be disenrolled from all Texas state health care programs, and claims and prior authorization requests will be denied.

The disenrollment date will be the revalidation expiration date and not a future date.

Providers can revalidate their enrollment in the Provider Enrollment and Management System (PEMS) up to 120 calendar days before their current revalidation due date.

Providers may find more information and begin their revalidations in PEMS through tmhp.com’s How To Apply for Enrollment page under “Determine Your Application Type.”

Important: Email Validation

To ensure that enrollment notifications are sent to the correct person, confirm that your email address is up to date in PEMS. The Provider Information tab of your National Provider Identifier (NPI) Enrollment Record displays an email address field.

Providers can access Verifying An Email In PEMS.

Provider Requirements

Revalidating providers may need to provide fingerprints, submit additional documentation, or complete other screening requirements.

Providers may view and confirm their revalidation date and enrollment information in PEMS. To reduce application time, have the following information available:

  • First and last name
  • Organization name
  • Social Security number
  • Date of birth
  • Employer’s Tax Identification Number and legal name
  • 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 documentation required for program participation

Providers revalidating an existing enrollment should continue to submit claims to meet their timely filing requirements.

Certain revalidating providers must pay an application fee. Refer to the State of Texas Provider Types Required to Pay an Application Fee document to determine which institutional providers must pay the provider enrollment application fee.

Providers can also refer to the current Texas Medicaid Provider Procedures Manual, Vol. 1, Provider Enrollment and Responsibilities, for more information.

To learn more about revalidation and the end of the COVID-19 public health emergency (PHE), refer to the web article that was posted to tmhp.com on March 4, 2023.

For more information, call the TMHP Contact Center at 800-925-9126.