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Telecommunication Provider Updates in PEMS

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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 July 1, 2024, providers approved to offer telecommunication services now have the option to indicate that they exclusively provide telehealth services or telemedicine services on their Provider Enrollment and Management System (PEMS) enrollment request.

If an out-of-state provider selects Yes to one of the telecommunication questions, then the licensing requirement for providing out-of-state services will be waived.

PEMS Updates

The following updates will be added to PEMS for telehealth and telemedicine providers:

  • The following questions for providers will be added to the Program and Services Participation Details page in PEMS:
    • Do you offer telehealth services? (Providers can choose Yes or No with a radio button to indicate Telehealth-Only or Telehealth & In Office.)
    • Do you offer telemedicine services? (Providers can choose Yes or No with a radio button to indicate Telemedicine-Only or Telemedicine & In Office.)

This information will indicate whether the provider is solely providing telehealth or telemedicine services.

Online Provider Lookup (OPL)

The TMHP Online Provider Lookup (OPL) allows users such as clients and providers to view telecommunication provider information:

  • When a user selects Telecommunication and refines the search using the advanced search filter by selecting Telemedicine or Telehealth, results will be displayed based on that selection in the following format:
  1. Providers without addresses listed in PEMS will be listed first and sorted alphabetically.
  2. Providers with addresses listed in PEMS will be listed next and sorted by distance near-to-far from the user’s address.

Once the search is complete, the following information for each provider listed will be displayed:

  • A map to the provider’s location will be available when in-person services are offered.
  • If the provider only offers online services, only the phone number of the provider will be displayed.
  • The provider’s phone number and the map to the provider’s location will be available if both services are offered.

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