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Providers Are Required to Maintain Surety Bonds in PEMS

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This article has been updated. To view the updated information, see Update to “Providers Are Required to Maintain Surety Bonds in PEMS”.

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 September 1, 2024, providers that are required to have a surety bond must have a surety bond on file. Failure to do so will result in claims denials for any locations subject to the surety bond requirement. Providers are required to maintain surety bonds in the Provider Enrollment and Management System (PEMS).

Providers must make these updates by September 1, 2024, to avoid being negatively impacted due to noncompletion.

In addition, providers must also renew their surety bonds prior to the surety bond expiration date.

The following provider types require a surety bond:

  • Durable Medical Equipment (DME)
  • Optician (group and individual locations only)
  • Orthotics and Prosthetics (group and individual locations only)
  • Pharmacy – CCP
  • Wheeled Mobility Services and Qualified Rehabilitation Professionals (QRP)
  • Ambulance/Air Ambulance (required for non-government-operated ambulance providers only)
  • Hyperalimentation

Providers can access PEMS to add or update their surety bond information. Providers can access their records by entering the provider National Provider Identifier (NPI) within PEMS. To make an addition or update surety bond information, a provider can create a PEMS Maintenance - Practice Location - Surety Bond request. This information may also be updated within a PEMS enrollment request.

For PEMS file maintenance assistance, see the video “File Maintenance Surety Bond,” on the TMHP YouTube channel.

Providers may also refer to the PEMS Instructional Site for guidance on completing the surety bond maintenance process in PEMS.

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