Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client’s specific MCO for details.
The Texas Medicaid & Healthcare Partnership’s (TMHP) Provider Enrollment and Management System (PEMS) is coming soon.
Provider enrollment functions will be available through PEMS, and providers must use the new system to enroll in Texas Medicaid.
The new system will be the single tool for provider enrollment, reenrollment, revalidation, and maintenance requests (maintaining and updating provider enrollment record information).
PEMS will automate and streamline the provider enrollment process by removing the requirement to use paper forms, simplifying the process for providers to complete their National Provider Identifier (NPI)-based enrollment. Providers or individuals who do not provide health-care services and are not required to have NPIs may have been issued Atypical Provider Identifiers (APIs). These providers should use their APIs.
Using PEMS will result in the following benefits:
- PEMS eliminates the need for multiple Texas Provider Identifiers (TPIs), allowing providers to interact with all Texas Medicaid records in a single, easy-to-use system.
- PEMS will allow Texas Medicaid enrollment in multiple state healthcare programs with a single application. Real-time data validation will reduce errors and expedite the enrollment process.
- The message dashboard will provide timely online email notifications and related correspondence.
- PEMS will offer real-time availability of changes made to provider information and instant access to the status of provider enrollment applications.
- PEMS will allow clients to locate providers faster with the expanded Online Provider Lookup search functionality.
PEMS Training and Resources
A PEMS instructional video can be accessed on the TMHP YouTube channel at the following link: “The Benefits of PEMS”
Additional information related to PEMS is available on the TMHP website: “The Benefits of PEMS”
PEMS Portal Effective December 13, 2021
Providers should plan for the following changes on December 13, 2021:
- PEMS will replace Provider Enrollment on the Portal (PEP) and the Provider Information Management System (PIMS).
- PEP and PIMS will no longer be available.
- Paper applications for Texas Medicaid provider enrollment will be eliminated with the new online system.
- Providers must have access to the internet to utilize PEMS and use up-to-date internet browsers for optimum performance of the PEMS portal. Use Google Chrome or Microsoft Edge to reduce compatibility issues.
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