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Provider Enrollment Revalidation Window Extended From 120 to 180 Days

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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 May 31, 2024, the provider enrollment revalidation timespan has been extended from 120 days to 180 days. Providers can now revalidate their enrollment in the Provider Enrollment and Management System (PEMS) up to 180 days before their revalidation due date.

Due to this change, updates are made to the timeline of the revalidation notifications that are sent to providers. Providers will now receive a 180-day notification to inform them that revalidation is open. Additional reminders will be sent 120, 90, and 45 days before the revalidation due date.

To receive the revalidation reminder notifications through email, providers should ensure that the email address in their PEMS profile is current. To update the email address, providers should enter their Enrollment Record in PEMS, select Edit Enrollment Record on the top header, and select Create Request for the request type of Maintenance – Provider Information – Change Email.

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