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Maiden or Alias Name Disclosure 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.

Providers and practice owners, creditors, or principals with a maiden name, alias, or nickname must disclose all maiden names, aliases, or nicknames ever used in the appropriate location in the Provider Enrollment and Management System (PEMS).

To disclose providers with a maiden name, alias, or nickname:

  1. Log in to PEMS.
  2. Navigate to the Provider Information Page.
  3. Enter the provider’s first and last name in the First Name and Last Name fields.
  4. If the provider has ever used another name, enter it in the Maiden Name, Alias or Nicknames ever used section.
  5. Select the type of name from the drop-down menu.
  6. Complete the First Name and Last Name fields in this section.

To enroll owners, creditors, or principals with a maiden name, alias, or nickname:

  1. Log in to PEMS.
  2. Open the Ownership Controlling Interest page.
  3. Navigate to the Basic Information tab of the Owners/Creditors/Principals section.
  4. Enter the individual’s first and last name in the First Name and Last Name fields.
  5. If the individual has ever used another name, enter it in the Maiden Name or Alias fields, as follows:
  • Maiden Name – Enter a first name and maiden last name. If there is more than one maiden last name, enter a semicolon after the initial first and maiden name combination, and then enter the additional first and maiden name combination.
  • Alias – Enter the alias first and last name. If there is more than one alias, enter any additional aliases, each separated with a semicolon.

When disclosing additional names, provide a complete name, including first and last name for each maiden name or alias entered. Failure to provide a complete first and last name for a maiden name or alias will result in an application deficiency notice and may delay processing of the enrollment application.

If the name has already been disclosed in the Maiden Name or Alias field or the First Name and Last Name fields, do not reenter the name.

If the individual does not have a maiden name or alias, do not complete the Maiden Name or Alias fields.

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