As a reminder, the Texas Medicaid & Healthcare Partnership (TMHP) will roll out the Provider Enrollment and Management System (PEMS) on September 30, 2024. All Provider enrollment functions will be accessible through PEMS, and Providers must use this new system to enroll in Texas Medicaid.
PEMS will serve as the sole tool for enrollment, re-enrollment, revalidation, and maintenance requests, including maintaining and updating provider enrollment records.
Key Details:
The Texas Medicaid & Healthcare Partnership (TMHP) identified some inconsistencies in Provider taxonomy codes and addresses during a recent review of enrollment information in the Provider Enrollment and Management System (PEMS).
Provider claims may be denied by the Texas Health and Human Services Commission, TMHP, MCOs, or dental maintenance organizations if taxonomy codes and/or addresses are not up to date.
Learn how to correct your taxonomy codes and address in PEMS below.
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.”
Correct Your Address in PEMS
TMHP has created a series of instructional how-to videos that explain the steps needed to update provider enrollment records, including how to update an existing address.
To view the completed series of instructional how-to videos, click here.
Important: If you need step-by-step instructions for submitting PEMS requests, use the PEMS Instructional Site.
https://www.tmhp.com/topics/provider-enrollment/pems/start-application
Next steps for Providers:
Providers should share this communication with their staff.
Resources:
- TMHP Contact Center: 800-925-9126 (Select option 3 for questions about updating Provider address)
- Community First Provider Relations: 210-358-6294 | ProviderRelations@cfhp.com
Community First Resources:
https://communityfirsthealthplans.com/provider-newsletter
https://communityfirsthealthplans.com/providers/
Contact:
Email ProviderRelations@cfhp.com or call 210-358-6294.