On December 13, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) and the Texas Health and Human Services Commission (HHSC) are taking two actions to extend revalidation due dates. For more information, review the Revalidation Due Date Extensions section below.
In January 2025, TMHP and HHSC plan to address enrollment gaps resulting from revalidation challenges. For more information, review the Retroactive Enrollment Period Effective Dates section below.
Providers that have started the revalidation or reenrollment process should complete applications and address any outstanding deficiencies as soon as possible to minimize any delays or challenges.
Providers that have not yet begun the revalidation process should start as soon as possible. Providers can start the revalidation process 180 calendar days prior to their revalidation due date. They can verify their revalidation due date on the Provider Information page in the Provider Enrollment and Management System (PEMS).
Revalidation Due Date Extensions:
On December 13, 2024, TMHP and HHSC are taking two actions to extend revalidation due dates.
Providers that are due for revalidation between December 13, 2024, and May 31, 2025, will receive an additional 180 calendar days to complete revalidation in PEMS. PEMS will check daily for all providers that are due for revalidation the following calendar day, and if the provider has not completed revalidation, PEMS will automatically add a one-time extension of 180 calendar days to the current revalidation due date.
Additionally, actively enrolled providers with revalidation due dates between November 1, 2024, and December 12, 2024, with an in-flight revalidation request as of December 13, 2024, will receive a one-time extension of 180 calendar days to their revalidation due date.
The extension will be reflected in the Revalidation Due Dates column found on the Provider Information page in PEMS. Providers will also receive an email notification confirming their new revalidation due date. This extension will allow providers additional time to submit and complete PEMS revalidation requests and prevent disenrollment.
Important: A provider’s revalidation is not complete until their revalidation request is in “closed-enrolled” status. Submitting the revalidation request is the first step of the process. The revalidation request must then go through the review process and be approved by TMHP.
Provider Enrollment Application Fee:
Certain providers must pay a provider enrollment application fee when applying for revalidation. Refer to the State of Texas Provider Types Required to Pay an Application Fee document to determine which institutional providers must pay the application fee.
Retroactive Enrollment Period Effective Dates:
TMHP and HHSC are developing a process to modify enrollment period effective dates for providers that:
- Have been disenrolled for failing to revalidate timely between November 1, 2023, and December 12, 2024.
- Successfully reenrolled in Texas Medicaid.
Beginning January 17, 2025, for providers that meet both these criteria, the provider’s National Provider Identifier (NPI) enrollment period begin date in PEMS will be backdated up to 365 calendar days to reduce or eliminate their enrollment gap.
Providers will receive an email notification with their new NPI enrollment period begin date.
Example 1 – Provider’s enrollment period gap exceeds 365 calendar days
In this scenario, the provider’s revalidation due date was 11/1/2023, and the provider was disenrolled for failing to revalidate timely effective 11/2/2023. The provider successfully reenrolled on 11/27/2024. After TMHP applies the retroactive grace period, the NPI enrollment period begin date in PEMS will be backdated 365 calendar days to 11/28/2023.
- Current enrollment periods:
- 2/1/2019–11/1/2023
- 11/27/2024–11/26/2029
- Revised enrollment periods after TMHP applies the retroactive grace period:
- 2/1/2019–11/1/2023
- 11/28/2023–11/26/2029
Example 2 – Provider’s enrollment period gap is less than 365 days, and entire gap closure occurs
In this scenario, the provider’s revalidation due date was 3/31/2024, and the provider was disenrolled for failing to revalidate timely effective 4/1/2024. The provider successfully reenrolled on 6/5/2024. After TMHP applies the retroactive grace period, the NPI enrollment period begin date in PEMS will be backdated to 4/1/2024 because the enrollment gap is less than 365 calendar days.
- Current enrollment periods:
- 4/1/2019–3/31/2024
- 6/5/2024–6/4/2029
- Revised enrollment periods after TMHP applies the retroactive grace period:
- 4/1/2019–3/31/2024
- 4/1/2024–6/4/2029
Claims Filing
TMHP will reprocess all claims for dates of service on or after the new NPI enrollment period begin date in PEMS. When the claims are reprocessed, providers may receive additional payment, which will be reflected on the Remittance and Status (R&S) Report. Providers should submit any held claims as soon as possible so they will be included in the reprocessing effort.
Note: Providers should contact Community First directly for details regarding claims submitted to us.
PEMS Revalidating and Reenrollment References
Providers may refer to the PEMS educational videos on TMHP’s Provider Enrollment & Management System Playlist on YouTube, which includes the following:
- Revalidating an Individual
- Revalidating a Performing Provider
- Revalidating a Clinic/Group Practice or Facility
The following resources provide more information about Medicaid provider revalidation requirements and common deficiencies to avoid:
- Common Deficiencies Identified by OIG
- Provider Enrollment Revalidation in PEMS
- ACA Screening Requirements
Providers may refer to the Provider Enrollment Help page or the PEMS Instructional Site on tmhp.com for additional revalidation or reenrollment support.
For more information, call the TMHP Contact Center at 800-925-9126.
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 210-358-6294. 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