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Updates to PEMS Effective November 22, 2024

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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 November 22, 2024, updates will be made to the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS).

Key Changes That Will Be Implemented

PEMS National Provider Identifier (NPI/Taxonomy Information Page) Updates

The NPI Taxonomy Information page STATUS field will be renamed “NPPES Status” to align with the source of the NPI Taxonomy Information provided by the National Plan and Provider Enumeration System (NPPES).

Note: The downloaded file from NPPES used to populate the PEMS NPPES Status will be updated nightly.

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A new Note has been added to the NPI Taxonomy Information page to educate the user that the NPPES Status is derived from the NPPES website.

This status is NOT the same status that PEMS uses to determine provider participation with TMHP.

The information that is displayed on this page reflects the provider’s NPI status in the NPPES NPI Registry. If any information (such as taxonomies) is incorrect or missing, providers must update their NPI record in NPPES. After updating, allow 24 hours and then click Refresh Information at the top right of this screen.

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Additional Updates

The following additional updates will be made:

  • Some providers with an Enrollment Status of Disenrolled are now also allowed to submit the following PEMS requests in addition to Reenrollment and the Maintenance-Provider Information-Change Email request.
    • Maintenance – W-9 / Tax Information
    • Maintenance – EFT

Note: Providers in the following programs will not be allowed to submit Maintenance – W-9 / Tax Information or Maintenance – Electronic Funds Transfer (EFT) requests when the NPI Enrollment Status is Disenrolled.

  • Long-Term Services and Supports (LTSS)
  • Medical Transportation Program Individual Transportation Participant (MTP-ITP)

After accessing PEMS from the TMHP Administrator account, the user must first enter their NPI in the Search NPI field of the Provider Management PEMS Dashboard. After searching the NPI record, select View found in the ellipsis (…) to the right. Once the NPI PEMS record is loaded, the user will select Edit Enrollment Record at the top right to see the allowed requests based on their PEMS Enrollment Status. 

  • PEMS will automatically calculate and update the NPI Enrollment Status by considering all program practice statuses. PEMS requests will now also display the NPI Enrollment Status in real time as seen in the NPI Only Approved Data.
  • The NPI Enrollment Status will no longer be based on the revalidation due date. It will now be calculated based on the program practice status and the NPI revalidation due date.
  • The Enrollment Period End Date on the Provider Information page will reflect the end date based on the latest Practice Location disenrollment date. When all practice locations are disenrolled, the latest practice location disenrollment date will be set as the latest enrollment period end date.

See below:

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