The Texas Medicaid & Healthcare Partnership (TMHP) is reviewing enrollment information for National Provider Identifier (NPI) in the Provider Enrollment and Management System (PEMS). During this review, discrepancies were found between the provider taxonomy codes in PEMS and those in the National Provider Plan and Enumeration System (NPPES).
If your PEMS taxonomy codes do not match the codes in NPPES, your claims may be denied by the Texas Health and Human Services Commission, TMHP, managed care organizations, or dental maintenance organizations.
Learn how to correct your taxonomy codes in PEMS and NPPES below.
Note: TMHP and Community First request that providers review and update practice addresses within PEMS. Learn more about changing your address in PEMS.
Key Details:
To Correct Your Taxonomy Codes in PEMS
Important: You must close any existing maintenance requests to create an Existing Enrollment request type (see step 4).
1. Go to PEMS.
2. View your Enrollment Record.
3. Click Edit Enrollment Record.
4. Create an Existing Enrollment request.
5. Enroll in a new or duplicate program to select the correct taxonomy. You can view instructions for this by visiting Provider Enrollment Help | TMHP, selecting “Video Tutorials and Demos,” and clicking “Add Practice Location.”
6. Disenroll from all the programs associated with incorrect taxonomy. You can view instructions for this by visiting Provider Enrollment Help | TMHP, selecting “Video Tutorials and Demos,” and clicking “Disenroll a Provider.”
Important: If you need step-by-step instructions for submitting PEMS requests, use the PEMS Instructional Site.
To Correct Your Taxonomy Codes in NPPES
1. Go to the NPPES website.
2. Login to your account.
3. Follow the instructions there for editing your taxonomy codes.
Resources:
If you have questions or need help with PEMS, contact the TMHP Contact Center at 800-925-9126. You can also contact your TMHP provider relations representative for additional help.
Next steps for Providers:
Providers should share this communication with their staff.
Community First Resources:
https://communityfirsthealthplans.com/provider-newsletter
https://communityfirsthealthplans.com/providers/
Contact:
Email ProviderRelations@cfhp.com or call 210-358-6294.