The Texas Health and Human Services Commission (HHSC) has announced updates to the rollout of the Provider Enrollment and Management System Plus (PEMS+). Community First Health Plans is sharing this important information to help Providers prepare for upcoming changes.
Timeline Updates:
- The transition to the new Master Provider File (MPF) is still set for May 30, 2025.
- The credentialing functionality in PEMS has been delayed until August 31, 2025.
These two changes were originally planned to launch at the same time, however HHSC will now stagger the rollout to minimize Provider disruption and address known data concerns.
What to Expect:
By May 30, 2025:
- HHSC will implement the new PEMS-based Master Provider File. Community First and other Medicaid health plans will begin using this updated file to manage Provider information. Providers should confirm their practice locations and other information is correct in PEMS as soon as possible. See our PEMS FAQ for more information on this topic.
- New formats for Provider Network Files (P-files), validations, and response files will be in effect by June 6, 2025.
By August 31, 2025:
- PEMS will begin supporting managed care credentialing.
- The rollout will take place in phases, starting with Providers undergoing initial credentialing with dental plans, followed by credentialing and recredentialing with health plans like Community First.
- HHSC will collaborate with MCOs to finalize the staged rollout plan.
What This Means for Providers:
At this time, no action is required from Providers related to credentialing in PEMS. Providers should continue using the current credentialing and recredentialing processes with Community First. The delay in launching credentialing functionality is intended to give HHSC and stakeholders more time to resolve technical issues and ensure a smoother rollout later this year.
It is important that all Providers ensure their Texas Medicaid enrollment remains current and accurate with TMHP, as this data will feed into the new Master Provider File. Keeping enrollment information up to date will help prevent any interruptions in contracting or claims processing when PEMS is fully implemented.
HHSC Resources:
- For questions about the PEMS go-live plan, email: ProviderEnrollmentManagementSystem@hhs.texas.gov
- HHSC TexConnect Notice (PDF)
- Provider Credentialing in PEMS Postponed
- PEMS FAQ
- Updates and Directions in Preparation for Implementation of PEMS Master Provider File Regarding Address Differences
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
To access all Provider alerts:
- Log into the Community First Provider Portal
- Go to CommunityFirstHealthPlans.com/Provider-News
- Sign up for the Community First Provider eNewsletter