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Reminder: Requirements for Provider Enrollment Revalidation

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Providers must meet all the timelines and requirements for revalidation to avoid an enrollment gap and delays in claims processing.

Providers can verify their revalidation date and enrollment information in the Provider Enrollment and Management System (PEMS).

Timeline

All providers must complete their revalidation enrollment before their current enrollment period ends. Provider revalidation requests must be in “closed-enrolled” status in PEMS to be considered complete.

Providers can revalidate their enrollment in PEMS up to 180 calendar days before their revalidation due date. For more information, visit the How to Apply for Enrollment page on tmhp.com, click on Determine Your Application Type, and scroll to the Revalidation heading.

Important: The Texas Medicaid & Healthcare Partnership (TMHP) will disenroll providers from all Texas state health care programs if they fail to complete the revalidation process by their deadline. TMHP will also deny all claims and prior authorization requests.

Note: Providers that are revalidating should continue to submit claims to ensure that they meet timely filing requirements.

Documentation

Revalidating providers may need to provide fingerprints, submit additional documentation, or complete other screening requirements.

To avoid delays, have the following information ready:

  • First and last name
  • Organization name
  • Social Security number
  • Date of birth
  • Employer Identification Number (EIN) and legal name
  • Licenses or certifications, if applicable
  • Documentation related to disclosures, if needed
  • Additional documentation required for program participation
  • Identification for the provider and any person who meets the definition of owner, creditor, principal, subcontractor, or managing employee

Note: For more information about “identification for the provider and any person who meets the definition of owner, creditor, principal, subcontractor, or managing employee,” providers may refer to these resource documents:

Application Fee

Some revalidating providers must pay an application fee. Refer to the document titled State of Texas Provider Types Required to Pay an Application Fee for details about which institutional providers need to pay the application fee.

Providers can refer to the Texas Medicaid Provider Procedures Manual, “Section 1, Provider Enrollment and Responsibilities” for information about enrollment requirements.

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