Attention all Laboratory Providers! Effective November 1, 2025, all Providers that submit claims for laboratory processes/procedures that require CLIA licensure must ensure their CLIA licensure and certification code(s) information is updated in the TMHP PEMS Enrollment System. HHSC requires that MCO claims systems be set up to link up the type of CLIA certification and billable procedure codes to determine how the procedures will process, depending on CLIA waived status and the provider’s CLIA certification type.
All providers that bill laboratory services must have CLIA certification for the procedure code being billed. If a provider bills for a procedure without appropriate CLIA certification, reimbursement must be denied.
Even if Provider’s have a copy of the CLIA license available, Community First will still be required to deny reimbursement if the information is not updated in the PEMS Master Provider File.
For questions or assistance in updating your information, please reach out to ProviderEnrollment@hhs.texas.gov.
For additional questions regarding this new requirement, please review the attached FAQ from HHSC.
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.
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