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Surety Bond Status Codes Effective September 1, 2024, Removed for Providers

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As of December 13, 2024, the Provider Enrollment and Management System (PEMS) will not automatically add Status Code 60 – “Surety Bond Has Expired” for providers that are required to have a surety bond on file.

Existing status code denials effective September 1, 2024, have also been removed. Providers can submit their claims for consideration while their surety bond information is being updated.

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 – Comprehensive Care Program (CCP)
  • Wheeled Mobility Services and Qualified Rehabilitation Professionals (QRP)
  • Ambulance/Air Ambulance (required for non-government-operated ambulance providers only)
  • Hyperalimentation (TPN)

Note: Nursing Facility (NF) providers are not required to submit a Texas Medicaid Provider Surety Bond.

Providers are still required to comply with Texas Administrative Code Title 1, Section 352.12. Providers that have an active surety bond must keep their surety bond on file and ensure that the information is accurate on the Practice Location - Program and Services Participation page.

Update Your Surety Bond Information in PEMS

To continue participating in Texas state health care programs, providers must update their surety bond information in PEMS by using one of the following options:

  • If providers are within their revalidation period, they must update their surety bond information through a revalidation request.
  • Providers with a disenrolled status must update their surety bond within a reenrollment request.
  • If the provider is actively enrolled in PEMS, they may update their surety bond information using the PEMS Maintenance – Practice Location – Surety Bond request or the PEMS – Existing Enrollment request.

Important: Claims and prior authorization requests may be denied until providers update their surety bond information, and the request is approved.

Providers will be notified in a separate article when TMHP will resume adding Status Code 60 – “Surety Bond Has Expired.”

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.