Instructions for Completing the Agreements & Signatures Page
Select the Application Type from the left navigation menu.
Section: Assign for Signature
For providers that are entities, facilities, groups, or organizations, the authorized representative with authority to sign on the provider’s behalf must do the following.
For Individuals, the Authorized Signatory will be defaulted to the enrolling provider’s name. You will be required to enter your email address:
For performing providers, the Authorized Signatory will be defaulted to the enrolling provider’s name. You will be required to enter their email address and have them log into Adobe Sign in order to proceed with signing the agreement.
Select the “Authorized Signatory” by clicking on the ellipses (…) under HHSC Enrollment Agreement. A drop-down menu will appear within the “Add Authorized Signatory “modal.
The drop-down menu will automatically populate with a list of the individuals designated on the Ownership/Controlling Interest page as authorized to negotiate contracts with HHSC and execute contracts on behalf of the entity.
If you don’t see the appropriate name on the drop-down list, you must add the person as an owner/creditor/principal to the “Designation of Authorized Individual(s)” list on the Ownership/Controlling Interest page and ensure that the disclosure questions have been completed for that individual.
Click Active Agreement.
The email address for the “Name of the Authorized Signatory” and the “Status of the Signature” will be displayed, and the Clear, Sign Agreements, and Remind/Re-send Email buttons will be enabled.
In order for the authorized individual to receive the email that prompts them for a signature, select Sign Agreements.
PEMS will send an email notification with subject line “Urgent, Your Signature is required” to the email address for the authorized individual for electronic signatures.
The email prompts the user to sign and complete the agreement after verifying his or her identity by entering the last four digits of their Social Security Number to access the agreement.
If the authorized individual has not received the email after 24 hours, you can select Remind/Re-send Email to send another email to the individual.
If you require the signature of the authorized individual to be removed, select Clear. After the signature is clear, repeat the process within this section.
Section: Authorized Representative Log In
When the Authorized Representative receives the email, they will be prompted to click the link that will take them to the Login screen. On this screen, they will enter their password as documented within the body of the email. o The last four digits of the Authorized Representative's License Number must be entered as the password to access a copy of the agreement for E-sign.
A “Complete the Agreement(s)” link embedded within the email will direct the user to Adobe Sign.
The user will be notified that the document is password protected.
The last four digits of the Authorized Representative's License Number must be entered as the password to access a copy of the agreement for E-sign.
Any issues with the password must be directed to the TMHP User Account administrator who completed the application in PEMS.
If the authorized individual decides that they do not want to e-sign, they should follow these steps: Click the link to Agreement; click the Options drop-down box; and select Decline to Sign.
The Adobe Sign pop-up window will appear.
Click Start to navigate to the next required field.
Select Click here to sign on the Provider’s Signature line to complete the e-signature.
The Adobe Sign pop-up window will appear.
Enter the full name of the Authorized Signatory in the “Type your Signature here” field and select Apply.
The enrolling provider must sign their name on this line.
The authorized signatory must type/sign their name on this line. Confirm that the Provider’s Signature line is accurate.
If not, select Click to Change.
If yes, select Click to Sign.
The “Enrollment Agreement confirmation” page will display the completed and signed agreement.
Select Download a copy to view or save a copy of the agreement.
Close the Adobe Sign pop-up window to save the agreement.
The status of the agreement will change from “Sent” to “Signed” in PEMS and “Sign Agreement” access will be disabled.
The signature will be present on the HHSC Agreement form in PEMS after the authorized individual submits their signature on the e-sign document.
Section: EFT Agreements
Select the “Authorized Signatory” by clicking on the ellipses (…) under HHSC Enrollment Agreement. A drop-down menu will appear within the “Add Authorized Signatory “modal.
The drop-down menu will be automatically populated a list of the names of the individual(s) designated in the Ownership/Controlling Interest page as authorized to negotiate contracts with the Health and Human Services Commission (HHSC) and to execute contracts on behalf of the entity.
If you don’t see the appropriate name on the menu’s list, you must add this person as an owner/creditor/principal and to the “Designation of Authorized Individual(s)” list within the Ownership/Controlling Interest page in PEMS and ensure the Disclosure questions have been completed for that individual.
Click Activate Agreement.
The email address for the Name of the Authorized Signatory and the Status of the Signature will be displayed, and "Clear", “Sign Agreements”, and “Remind/Re-send Email” buttons will be enabled.
The email address for the Name of the Authorized Signatory and the Status of the Signature will be displayed, and "Clear", “Sign Agreements”, and “Remind/Re-send Email” buttons will be enabled.
PEMS will send an email notification with subject line “Urgent, Your Signature is required” to the email address associated to the Name of the Authorized Individual for electronic signatures.
The email prompts the user to sign and complete the agreement after verifying his or her identity by entering the last four digits of the Social Security Number to access the agreement.
If the Authorized Individual has not yet received the email after 24 hours, you may select “Remind/Re-send Email” to generate and send another email to the individual.
When the Authorized Individual receives the email, they will be prompted to click the link that will take them to the Login screen. On this screen, they will enter their password as documented within the body of the email.
A “Complete the Agreement(s)” link embedded within the email will direct the user to Adobe Echo Sign.
The user will be notified that the document is password protected.
The last four digits of the Social Security Number that was provided for the Authorized Signatory in PEMS must be entered as the password to access a copy of the agreement for E-sign.
Click Start to navigate to the next required field.
5. Enter the Date Agreement is effective with the referring/consulting/Authorized Representative.
Enter in today's date.
Select “Click here to sign” on the Physician Signature line to complete the e-signature.
The EchoSign pop-up window will appear.
Enter your full name of the Authorized Signatory in the “Type your Signature here” field and select Apply.
The Authorized Representative must type/sign their name on this line. Confirm the Physician Signature line is accurate.
If not, select “Click to Change”.
If yes, select "Click to Sign".
The “Enrollment Agreement confirmation” page will display the completed and signed agreement.
Select Download a copy to view or save a copy of the agreement.
Close the EchoSign pop-up window to save the agreement.
The status of the agreement will change from “Sent” to “Signed” in PEMS, and “Sign Agreement” access will be disabled.
The signature will be present on the EFT Agreement form in PEMS.
Section: Request Submission
The agreement must be completed and reflect “Signed” before the application is submitted.
Note: If the TMHP User Account that initiated the enrollment request is different from the TMHP User Account that electronically signed the agreement, a user with the appropriate permissions must log in to My Account to access PEMS and complete the submission process.
The authorized individual must also check the box that attests "I have read and agree to HHSC Provider Agreement" before the enrollment can be completed and submitted.
Click Complete & Submit Enrollment
Note: All fields and buttons will be grayed out.
Warning: Once you submit the application, you can’t modify it.
Instructions for Completing the Agreements & Signatures Page
Note: This page does not apply to Ordering and Referring Providers.
Section: Assign for Signature
For performing providers, the Authorized Signatory will be defaulted to the enrolling provider’s name. You will be required to enter their email address and have them log into Adobe Sign in order to proceed with signing the agreement.
The “Authorized Signatory” will be pre-populated with the enrolling provider’s name.
Enter the email address for the performing provider.
Click Active Agreement.
PEMS will send an email notification with subject line “Urgent, Your Signature is required” to the email address associated to the performing provider for electronic signatures .
The email prompts the user to sign and complete the agreement after verifying his or her identity by entering the last four digits of their Social Security Number to access the agreement.
If the performing provider has not yet received the email after 24 hours, you may select “Remind/Re-send Email” to generate and send another email to the individual.
If you require the signature of the performing provider to be removed, you will select the clear button. After the signature is clear, repeat the process within this section.
Section: Authorized Representative Log In
When the performing provider receives the email, they will be prompted to click the link that will take them to the Login screen. On this screen, they will enter their password as documented within the body of the email.
A “Complete the Agreement(s)” link embedded within the email will direct the user to Adobe Sign.
The user will be notified that the document is password protected.
The last four digits of the Authorized Representative's License Number must be entered as the password to access a copy of the agreement for E-sign.
Any issues with the password must be directed to the TMHP User Account administrator who completed the application in PEMS.
If the performing provider decides they do not want to e-sign, after clicking on the Link to Agreement, they will click the Options drop-down box and select, “Decline to Sign”.
Section: Adobe E-sign
Click Start to navigate to the next required field.
Select “Click here to sign” on the Provider’s Signature line to complete the e-signature.
The EchoSign pop-up window will appear.
Enter your full name of the Authorized Signatory in the “Type your Signature here” field and select Apply.
The enrolling provider must sign their name on this line.
The authorized signatory must type/sign their name on this line. Confirm the Provider’s Signature line is accurate.
If not, select “Click to Change”.
If yes, select "Click to Sign".
The “Enrollment Agreement confirmation” page will display the completed and signed agreement.
Select Download a copy to view or save a copy of the agreement.
Close the EchoSign pop-up window to save the agreement.
The status of the agreement will change from “Sent” to “Signed” in PEMS, and “Sign Agreement” access will be disabled.
The signature will be present on the HHSC Agreement form in PEMS after the Authorized Individual submits their signature on the E-sign document.
Section: Physicians Letter of Agreement
Note: This section will only appear if your provider type requires a Physicians Letter of Agreement.
Add/Change the email for the Authorized Representative, also known as the Authorized Signatory for the "Physician's Letter of Agreement”, by clicking on the ellipses (…) .
The drop-down menu will be automatically populated a list of the names of the individual(s) designated in the Ownership/Controlling Interest page as authorized to negotiate contracts with the Health and Human Services Commission (HHSC) and to execute contracts on behalf of the entity.
If you don’t see the appropriate name on the menu’s list, you must add this person as an owner/creditor/principal and to the “Designation of Authorized Individual(s)” list within the Ownership/Controlling Interest page in PEMS and ensure the Disclosure questions have been completed for that individual.
Click Activate Agreement.
The email address for the Name of the Authorized Signatory and the Status of the Signature will be displayed, and "Clear", “Sign Agreements”, and “Remind/Re-send Email” buttons will be enabled.
In order for the Authorized Signatory to receive the email to prompt them for a signature, you will select “Sign Agreements”.
PEMS will send an email notification with subject line “Urgent, Your Signature is required” to the email address associated to the Name of the Authorized Individual for electronic signatures.
The email prompts the user to sign and complete the agreement after verifying his or her identity by entering the last four digits of the Social Security Number to access the agreement.
If the Authorized Representative has not yet received the email after 24 hours, you may select “Remind/Re-send Email” to generate and send another email to the individual.
When the Authorized Representative receives the email, they will be prompted to click the link that will take them to the Login screen. On this screen, they will enter their password as documented within the body of the email.
A “Complete the Agreement(s)” link embedded within the email will direct the user to Adobe Echo Sign.
The user will be notified that the document is password protected.
The last four digits of the Social Security Number that was provided for the Authorized Signatory in PEMS must be entered as the password to access a copy of the agreement for E-sign.
Click Start to navigate to the next required field.
Enter the Date Agreement is effective with the referring/consulting/Authorized Representative.
Enter in today's date.
Select “Click here to sign” on the Physician Signature line to complete the e-signature.
The EchoSign pop-up window will appear.
Enter your full name of the Authorized Signatory in the “Type your Signature here” field and select Apply.
Enter your full name of the Authorized Signatory in the “Type your Signature here” field and select Apply.
The enrolling provider must sign their name on this line.
The authorized signatory must type/sign their name on this line. Confirm the Provider’s Signature line is accurate.
If not, select “Click to Change”.
If yes, select "Click to Sign".
The “Enrollment Agreement confirmation” page will display the completed and signed agreement.
Select Download a copy to view or save a copy of the agreement.
Close the EchoSign pop-up window to save the agreement.
The status of the agreement will change from “Sent” to “Signed” in PEMS, and “Sign Agreement” access will be disabled.
Section: Request Submission
The agreement must be completed and reflect “Signed” before the application is submitted.
Note: If the TMHP User Account that initiated the enrollment request is different from the TMHP User Account that electronically signed the agreement, a user with the appropriate permissions must log in to My Account to access PEMS and complete the submission process.
The authorized individual must also check the box that attests "I have read and agree to HHSC Provider Agreement" before the enrollment can be completed and submitted.
Click Complete & Submit Enrollment
Note: All fields and buttons will be grayed out.
Warning: Once you submit the application, you can’t modify it.
Instructions for Completing the Agreements & Signatures Page
Note: This page does not apply to Ordering and Referring Providers.
Section: Assign for Signature
The “Authorized Signatory” will be pre-populated with the enrolling provider’s name.
For performing providers, the Authorized Signatory will be defaulted to the enrolling provider’s name. You will be required to enter their email address and have them log into Adobe Sign in order to proceed with signing the agreement.
Enter the email address for the performing provider.
Click Active Agreement.
PEMS will send an email notification with subject line “Urgent, Your Signature is required” to the email address associated to the performing provider for electronic signatures .
The email prompts the user to sign and complete the agreement after verifying his or her identity by entering the last four digits of their Social Security Number to access the agreement.
If the performing provider has not yet received the email after 24 hours, you may select “Remind/Re-send Email” to generate and send another email to the individual.
If you require the signature of the performing provider to be removed, you will select the clear button. After the signature is clear, repeat the process within this section.
Section: Authorized Representative Log In
When the performing provider receives the email, they will be prompted to click the link that will take them to the Login screen. On this screen, they will enter their password as documented within the body of the email.
A “Complete the Agreement(s)” link embedded within the email will direct the user to Adobe Sign.
The user will be notified that the document is password protected.
The last four digits of the performing provider's SSN must be entered as the password to access a copy of the agreement for E-sign.
Any issues with the password must be directed to the TMHP User Account administrator who completed the application in PEMS.
If the performing provider decides they do not want to e-sign, after clicking on the Link to Agreement, they will click the Options drop-down box and select, “Decline to Sign”.
Section: Adobe E-sign
** For group initiated performing provider applications **
A PDF file will be generated with all the information provided on the application at the time the agreement was sent. Please review all information is correct, once verified, towards the bottom of the document you will find the HHSC agreement needing to be e-signed.
Click Start to navigate to the next required field.
Select “Click here to sign” on the Provider’s Signature line to complete the e-signature.
The EchoSign pop-up window will appear.
Enter your full name of the Authorized Signatory in the “Type your Signature here” field and select Apply.
The enrolling provider must sign their name on this line.
The authorized signatory must type/sign their name on this line. Confirm the Provider’s Signature line is accurate.
If not, select “Click to Change”.
If yes, select "Click to Sign".
The “Enrollment Agreement confirmation” page will display the completed and signed agreement.
Select Download a copy to view or save a copy of the agreement.
Close the EchoSign pop-up window to save the agreement.
The status of the agreement will change from “Sent” to “Signed” in PEMS, and “Sign Agreement” access will be disabled.
The signature will be present on the HHSC Agreement form in PEMS after the Authorized Individual submits their signature on the E-sign document.
Section: Physians Letter of Agreement
Note: This section will only appear if your provider type requires a Physicians Letter of Agreement.
Add/Change the email for the Authorized Representative, also known as the Authorized Signatory for the "Physician's Letter of Agreement”, by clicking on the ellipses (…) .
The drop-down menu will be automatically populated a list of the names of the individual(s) designated in the Ownership/Controlling Interest page as authorized to negotiate contracts with the Health and Human Services Commission (HHSC) and to execute contracts on behalf of the entity.
If you don’t see the appropriate name on the menu’s list, you must add this person as an owner/creditor/principal and to the “Designation of Authorized Individual(s)” list within the Ownership/Controlling Interest page in PEMS and ensure the Disclosure questions have been completed for that individual.
Click Activate Agreement.
The email address for the Name of the Authorized Signatory and the Status of the Signature will be displayed, and "Clear", “Sign Agreements”, and “Remind/Re-send Email” buttons will be enabled.
In order for the Authorized Signatory to receive the email to prompt them for a signature, you will select “Sign Agreements”.
PEMS will send an email notification with subject line “Urgent, Your Signature is required” to the email address associated to the Name of the Authorized Individual for electronic signatures.
The email prompts the user to sign and complete the agreement after verifying his or her identity by entering the last four digits of the Social Security Number to access the agreement.
If the Authorized Representative has not yet received the email after 24 hours, you may select “Remind/Re-send Email” to generate and send another email to the individual.
When the Authorized Representative receives the email, they will be prompted to click the link that will take them to the Login screen. On this screen, they will enter their password as documented within the body of the email.
A “Complete the Agreement(s)” link embedded within the email will direct the user to Adobe Echo Sign.
The user will be notified that the document is password protected.
The last four digits of the Social Security Number that was provided for the Authorized Signatory in PEMS must be entered as the password to access a copy of the agreement for E-sign.
Click Start to navigate to the next required field.
Enter the Date Agreement is effective with the referring/consulting/Authorized Representative.
Enter in today's date.
Select “Click here to sign” on the Physician Signature line to complete the e-signature.
The EchoSign pop-up window will appear.
Enter your full name of the Authorized Signatory in the “Type your Signature here” field and select Apply.
The Authorized Representative must type/sign their name on this line. Confirm the Physician Signature line is accurate.
If not, select “Click to Change”.
If yes, select "Click to Sign".
The “Enrollment Agreement confirmation” page will display the completed and signed agreement.
Select Download a copy to view or save a copy of the agreement.
Close the EchoSign pop-up window to save the agreement.
The status of the agreement will change from “Sent” to “Signed” in PEMS, and “Sign Agreement” access will be disabled.
The signature will be present on the Physician's Letter of Agreement form in PEMS.
Section: Request Submission
The agreement must be completed and reflect “Signed” before the application is submitted.
Note: If the TMHP User Account that initiated the enrollment request is different from the TMHP User Account that electronically signed the agreement, a user with the appropriate permissions must log in to My Account to access PEMS and complete the submission process.
The authorized individual must also check the box that attests "I have read and agree to HHSC Provider Agreement" before the enrollment can be completed and submitted.
Click Complete & Submit Enrollment
Note: All fields and buttons will be grayed out.
Warning: Once you submit the application, you can’t modify it.
Instructions for Completing the Agreements & Signatures Page
Note: This page does not apply to Ordering and Referring Providers.
Section: Assign for Signature
The “Authorized Signatory” will be pre-populated with the enrolling provider’s name.
For performing providers, the Authorized Signatory will be defaulted to the enrolling provider’s name. You will be required to enter their email address and have them log into Adobe Sign in order to proceed with signing the agreement.
Enter the email address for the performing provider.
Click Active Agreement.
PEMS will send an email notification with subject line “Urgent, Your Signature is required” to the email address associated to the performing provider for electronic signatures .
The email prompts the user to sign and complete the agreement after verifying his or her identity by entering the last four digits of their Social Security Number to access the agreement.
If the performing provider has not yet received the email after 24 hours, you may select “Remind/Re-send Email” to generate and send another email to the individual.
If you require the signature of the performing provider to be removed, you will select the clear button. After the signature is clear, repeat the process within this section.
Section: Authorized Representative Log In
When the performing provider receives the email, they will be prompted to click the link that will take them to the Login screen. On this screen, they will enter their password as documented within the body of the email.
A “Complete the Agreement(s)” link embedded within the email will direct the user to Adobe Sign.
The user will be notified that the document is password protected.
The last four digits of the Authorized Representative's License Number must be entered as the password to access a copy of the agreement for E-sign.
Any issues with the password must be directed to the TMHP User Account administrator who completed the application in PEMS.
If the performing provider decides they do not want to e-sign, after clicking on the Link to Agreement, they will click the Options drop-down box and select, “Decline to Sign”.
Section: Adobe E-sign
Click Start to navigate to the next required field.
Select “Click here to sign” on the Provider’s Signature line to complete the e-signature.
The EchoSign pop-up window will appear.
Enter your full name of the Authorized Signatory in the “Type your Signature here” field and select Apply.
The enrolling provider must sign their name on this line.
The authorized signatory must type/sign their name on this line. Confirm the Provider’s Signature line is accurate.
If not, select “Click to Change”.
If yes, select "Click to Sign".
The “Enrollment Agreement confirmation” page will display the completed and signed agreement.
Select Download a copy to view or save a copy of the agreement.
Close the EchoSign pop-up window to save the agreement.
The status of the agreement will change from “Sent” to “Signed” in PEMS, and “Sign Agreement” access will be disabled.
The signature will be present on the HHSC Agreement form in PEMS after the Authorized Individual submits their signature on the E-sign document.
Section: Physician Letter of Agreement
Note: This section will only appear if your provider type requires a Physicians Letter of Agreement.
Add/Change the email for the Authorized Representative, also known as the Authorized Signatory for the "Physician's Letter of Agreement”, by clicking on the ellipses (…) .
The drop-down menu will be automatically populated a list of the names of the individual(s) designated in the Ownership/Controlling Interest page as authorized to negotiate contracts with the Health and Human Services Commission (HHSC) and to execute contracts on behalf of the entity.
If you don’t see the appropriate name on the menu’s list, you must add this person as an owner/creditor/principal and to the “Designation of Authorized Individual(s)” list within the Ownership/Controlling Interest page in PEMS and ensure the Disclosure questions have been completed for that individual.
Click Activate Agreement.
The email address for the Name of the Authorized Signatory and the Status of the Signature will be displayed, and "Clear", “Sign Agreements”, and “Remind/Re-send Email” buttons will be enabled.
In order for the Authorized Signatory to receive the email to prompt them for a signature, you will select “Sign Agreements”.
PEMS will send an email notification with subject line “Urgent, Your Signature is required” to the email address associated to the Name of the Authorized Individual for electronic signatures.
The email prompts the user to sign and complete the agreement after verifying his or her identity by entering the last four digits of the Social Security Number to access the agreement.
If the Authorized Representative has not yet received the email after 24 hours, you may select “Remind/Re-send Email” to generate and send another email to the individual.
When the Authorized Representative receives the email, they will be prompted to click the link that will take them to the Login screen. On this screen, they will enter their password as documented within the body of the email.
A “Complete the Agreement(s)” link embedded within the email will direct the user to Adobe Echo Sign.
The user will be notified that the document is password protected.
The last four digits of the Social Security Number that was provided for the Authorized Signatory in PEMS must be entered as the password to access a copy of the agreement for E-sign.
Click Start to navigate to the next required field.
Enter the Date Agreement is effective with the referring/consulting/Authorized Representative.
Enter in today's date.
Select “Click here to sign” on the Physician Signature line to complete the e-signature.
The EchoSign pop-up window will appear.
Enter your full name of the Authorized Signatory in the “Type your Signature here” field and select Apply.
The Authorized Representative must type/sign their name on this line. Confirm the Physician Signature line is accurate.
If not, select “Click to Change”.
If yes, select "Click to Sign".
The “Enrollment Agreement confirmation” page will display the completed and signed agreement.
Select Download a copy to view or save a copy of the agreement.
Close the EchoSign pop-up window to save the agreement.
The status of the agreement will change from “Sent” to “Signed” in PEMS, and “Sign Agreement” access will be disabled.
The signature will be present on the Physician's Letter of Agreement form in PEMS.
Section: Request Submission
The agreement must be completed and reflect “Signed” before the application is submitted.
Note: If the TMHP User Account that initiated the enrollment request is different from the TMHP User Account that electronically signed the agreement, a user with the appropriate permissions must log in to My Account to access PEMS and complete the submission process.
The authorized individual must also check the box that attests "I have read and agree to HHSC Provider Agreement" before the enrollment can be completed and submitted.
Click Complete & Submit Enrollment
Note: All fields and buttons will be grayed out.
Warning: Once you submit the application, you can’t modify it.
Instructions for Completing the Agreements & Signatures Page
Note: This page does not apply to Ordering and Referring Providers.
Section: Assign for Signature
The “Authorized Signatory” will be pre-populated with the enrolling provider’s name.
For performing providers, the Authorized Signatory will be defaulted to the enrolling provider’s name. You will be required to enter their email address and have them log into Adobe Sign in order to proceed with signing the agreement.
Enter the email address for the performing provider.
Click Active Agreement.
PEMS will send an email notification with subject line “Urgent, Your Signature is required” to the email address associated to the performing provider for electronic signatures .
The email prompts the user to sign and complete the agreement after verifying his or her identity by entering the last four digits of their Social Security Number to access the agreement.
If the performing provider has not yet received the email after 24 hours, you may select “Remind/Re-send Email” to generate and send another email to the individual.
If you require the signature of the performing provider to be removed, you will select the clear button. After the signature is clear, repeat the process within this section.
Section: Authorized Representative Log In
When the performing provider receives the email, they will be prompted to click the link that will take them to the Login screen. On this screen, they will enter their password as documented within the body of the email.
A “Complete the Agreement(s)” link embedded within the email will direct the user to Adobe Sign.
The user will be notified that the document is password protected.
The last four digits of the Authorized Representative's License Number must be entered as the password to access a copy of the agreement for E-sign.
Any issues with the password must be directed to the TMHP User Account administrator who completed the application in PEMS.
If the performing provider decides they do not want to e-sign, after clicking on the Link to Agreement, they will click the Options drop-down box and select, “Decline to Sign”.
Section: Adobe E-sign
Click Start to navigate to the next required field.
Select “Click here to sign” on the Provider’s Signature line to complete the e-signature.
The EchoSign pop-up window will appear.
Enter your full name of the Authorized Signatory in the “Type your Signature here” field and select Apply.
The enrolling provider must sign their name on this line.
The authorized signatory must type/sign their name on this line. Confirm the Provider’s Signature line is accurate.
If not, select “Click to Change”.
If yes, select "Click to Sign".
The “Enrollment Agreement confirmation” page will display the completed and signed agreement.
Select Download a copy to view or save a copy of the agreement.
Close the EchoSign pop-up window to save the agreement.
The status of the agreement will change from “Sent” to “Signed” in PEMS, and “Sign Agreement” access will be disabled.
The signature will be present on the HHSC Agreement form in PEMS after the Authorized Individual submits their signature on the E-sign document.
Section: Physician Letter of Agreement
Note: This section will only appear if your provider type requires a Physicians Letter of Agreement.
Add/Change the email for the Authorized Representative, also known as the Authorized Signatory for the "Physician's Letter of Agreement”, by clicking on the ellipses (…) .
The drop-down menu will be automatically populated a list of the names of the individual(s) designated in the Ownership/Controlling Interest page as authorized to negotiate contracts with the Health and Human Services Commission (HHSC) and to execute contracts on behalf of the entity.
If you don’t see the appropriate name on the menu’s list, you must add this person as an owner/creditor/principal and to the “Designation of Authorized Individual(s)” list within the Ownership/Controlling Interest page in PEMS and ensure the Disclosure questions have been completed for that individual.
Click Activate Agreement.
The email address for the Name of the Authorized Signatory and the Status of the Signature will be displayed, and "Clear", “Sign Agreements”, and “Remind/Re-send Email” buttons will be enabled.
In order for the Authorized Signatory to receive the email to prompt them for a signature, you will select “Sign Agreements”.
PEMS will send an email notification with subject line “Urgent, Your Signature is required” to the email address associated to the Name of the Authorized Individual for electronic signatures.
The email prompts the user to sign and complete the agreement after verifying his or her identity by entering the last four digits of the Social Security Number to access the agreement.
If the Authorized Representative has not yet received the email after 24 hours, you may select “Remind/Re-send Email” to generate and send another email to the individual.
When the Authorized Representative receives the email, they will be prompted to click the link that will take them to the Login screen. On this screen, they will enter their password as documented within the body of the email.
A “Complete the Agreement(s)” link embedded within the email will direct the user to Adobe Echo Sign.
The user will be notified that the document is password protected.
The last four digits of the Social Security Number that was provided for the Authorized Signatory in PEMS must be entered as the password to access a copy of the agreement for E-sign.
Click Start to navigate to the next required field.
Enter the Date Agreement is effective with the referring/consulting/Authorized Representative.
Enter in today's date.
Select “Click here to sign” on the Physician Signature line to complete the e-signature.
The EchoSign pop-up window will appear.
Enter your full name of the Authorized Signatory in the “Type your Signature here” field and select Apply.
The Authorized Representative must type/sign their name on this line. Confirm the Physician Signature line is accurate.
If not, select “Click to Change”.
If yes, select "Click to Sign".
The “Enrollment Agreement confirmation” page will display the completed and signed agreement.
Select Download a copy to view or save a copy of the agreement.
Close the EchoSign pop-up window to save the agreement.
The status of the agreement will change from “Sent” to “Signed” in PEMS, and “Sign Agreement” access will be disabled.
The signature will be present on the Physician's Letter of Agreement form in PEMS.
Section: Request Submission
The agreement must be completed and reflect “Signed” before the application is submitted.
Note: If the TMHP User Account that initiated the enrollment request is different from the TMHP User Account that electronically signed the agreement, a user with the appropriate permissions must log in to My Account to access PEMS and complete the submission process.
The authorized individual must also check the box that attests "I have read and agree to HHSC Provider Agreement" before the enrollment can be completed and submitted.
Click Complete & Submit Enrollment
Note: All fields and buttons will be grayed out.
Warning: Once you submit the application, you can’t modify it.
Instructions for Completing the Agreements & Signatures Page
Section: Assign for Signature
For performing providers, the Authorized Signatory will be defaulted to the enrolling provider’s name. You will be required to enter their email address and have them log into Adobe Sign in order to proceed with signing the agreement.
Select the “Authorized Signatory” by clicking on the ellipses (…) under HHSC Enrollment Agreement. A drop-down menu will appear within the “Add Authorized Signatory “modal.
The drop-down menu will automatically populate with a list of the individuals designated on the Ownership/Controlling Interest page as authorized to negotiate contracts with HHSC and execute contracts on behalf of the entity.
Email Address – Enter the email address of the enrolling individual who will receive the required HHSC Agreement for electronic signature.
Email Address – Enter the email address of the enrolling individual who will receive the required HHSC Agreement for electronic signature.
If you don’t see the appropriate name on the drop-down list, you must add the person as an owner/creditor/principal to the “Designation of Authorized Individual(s)” list on the Ownership/Controlling Interest page and ensure that the disclosure questions have been completed for that individual.
Click Active Agreement.
The email prompts the user to sign and complete the agreement after verifying his or her identity by entering the last four digits of their Social Security Number to access the agreement.
If the authorized individual has not received the email after 24 hours, you can select Remind/Re-send Email to send another email to the individual.
If you require the signature of the authorized individual to be removed, select Clear. After the signature is clear, repeat the process within this section.
Section: Authorized Representative Log In
When the Authorized Representative receives the email, they will be prompted to click the link that will take them to the Login screen. On this screen, they will enter their password as documented within the body of the email. o The last four digits of the Authorized Representative's License Number must be entered as the password to access a copy of the agreement for E-sign.
A “Complete the Agreement(s)” link embedded within the email will direct the user to Adobe Sign.
The user will be notified that the document is password protected.
The last four digits of the Authorized Representative's Social Security Number must be entered as the password to access a copy of the agreement for E-sign.
Any issues with the password must be directed to the TMHP User Account administrator who completed the application in PEMS.
If the authorized individual decides that they do not want to e-sign, they should follow these steps: Click the link to Agreement; click the Options drop-down box; and select Decline to Sign.
The Adobe Sign pop-up window will appear.
Click Start to navigate to the next required field.
Select Click here to sign on the Provider’s Signature line to complete the e-signature.
The Adobe Sign pop-up window will appear.
Enter the full name of the Authorized Signatory in the “Type your Signature here” field and select Apply.
The enrolling provider must sign their name on this line.
The authorized signatory must type/sign their name on this line. Confirm that the Provider’s Signature line is accurate.
If not, select Click to Change.
If yes, select Click to Sign.
The “Enrollment Agreement confirmation” page will display the completed and signed agreement.
Select Download a copy to view or save a copy of the agreement.
Close the Adobe Sign pop-up window to save the agreement.
The status of the agreement will change from “Sent” to “Signed” in PEMS and “Sign Agreement” access will be disabled.
The signature will be present on the HHSC Agreement form in PEMS after the authorized individual submits their signature on the e-sign document.
Section: EFT Agreements
The EFT Agreement is not required when enrolling as an Ordering- or Referring-Only provider.
*If an EFT segment was entered in the PEMS request, the EFT Agreement will display.
Section: Request Submission
The agreement must be completed and reflect “Signed” before the application is submitted.
Note: If the TMHP User Account that initiated the enrollment request is different from the TMHP User Account that electronically signed the agreement, a user with the appropriate permissions must log in to My Account to access PEMS and complete the submission process.
The Authorized Individual must also check the box that attests "I have read and agree to HHSC Vendor Drug Program Agreement" before the enrollment can be completed and submitted.
Click Complete & Submit Enrollment
Note: All fields and buttons will be grayed out.
Warning: Once you submit the application, you can’t modify it.