Community First Health Plans would like to inform providers that the effective date for Provider Enrollment and Management System (PEMS) is now May 30, 2025. The collaborative testing between Managed Care Organizations (MCOs) and Health and Human Services Commission (HHSC) determined that there are some providers with mismatched addresses in PEMS.
Key Details:
The Texas Medicaid & Healthcare Partnership (TMHP) identified some inconsistencies in Provider addresses during a recent review of enrollment information in PEMS.
Provider claims may be rejected by the Texas Health and Human Services Commission, TMHP, MCOs, or dental maintenance organizations if addresses are not up to date.
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 address for an existing address on file
- How to add a practice location to a group or individual’s enrollment record
- How to add a performing provider to an existing group
- How to submit a license update request
- How to update practice demographic information
To view the completed series of PEMS how-to YouTube videos, click here.
As a reminder, PEMS will serve as the sole tool for enrollment, re-enrollment, revalidation, and maintenance requests, including maintaining and updating provider enrollment records.
Verify Your Address With Community First:
Please use our Provider Information Change Form to report any changes to practice address(es) to Community First.
Next steps for Providers:
Providers must follow the PEMS guidance provided in this communication. Meeting the address synchronization between MCOs and PEMS will proportionately reduce claim denials for providers and improve the accuracy of encounter reporting and network adequacy to MCOs.
TMHP Resources:
- TMHP Contact Center: 800-925-9126 (Select option 3 for questions about updating Provider address)
- TMHP PEMS Email: ProviderRelations@tmhp.com
- PEMS Best Practices Guide
- PEMS Provider Enrollment Help
- TMHP PEMS YouTube Video Library
Community First Resources:
Contact:
Email ProviderRelations@cfhp.com or call 210-358-6294.
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