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Deficiency Limit for PEMS Requests Extended to 165 Business Days

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Providers currently have 45 cumulative business days to address all deficiencies on a request submitted in the Provider Enrollment and Management System (PEMS).

PEMS tracks the number of days a request is in the provider’s work queue for deficiency corrections. After 45 cumulative business days in the provider’s work queue, the request is automatically closed.

A cumulative time calculates the total number of days an application is out for a provider to address identified deficiencies. This calculator currently allows for a total of 45 business days and will be extended to 165 business days. If a provider's application has outstanding deficiencies that exceed the cumulative calendar days allotted, then the application will be closed, and the provider will need to create a new application request.

Note: Applications that have been reviewed by the Office of Inspector General (OIG) and the Texas Health and Human Services Commission (HHSC) may receive an additional 15 business-day extension so any outstanding deficiencies can be addressed.

Effective December 13, 2024, PEMS will be updated to extend the deficiency timeline for all provider request types (including new, existing, revalidation, reenrollment, and maintenance types) from 45 business days to 165 business days. This extension will allow providers sufficient time to complete their requests and address deficiencies without automatic closing of the request.

To prevent the request from closing, providers should respond within the remaining provider deficiency business-day limit. The application will automatically close if providers do not respond by the total provider deficiency business-day limit.

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.

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