Provider Enrollment and Management System (PEMS) Post-Deployment Update

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Since the deployment of the Provider Enrollment and Management System (PEMS), the Texas Medicaid & Healthcare Partnership (TMHP) has heard from many providers and used their feedback to enhance the provider user experience.

Claims by First-time Enrolling Providers

Newly enrolled providers may refer to the current Texas Medicaid Provider Procedures Manual, Section 6, “Claims Filing,” for more information regarding enrollment and claims filing.

Key Changes That Have Been Implemented

Physical Therapy/Occupational Therapy Groups

The Medicare Program Specific Questions will now display for Physical/Occupational Therapy groups in PEMS.

Display Practice Location - Physician Letter of Agreement

The performing provider Physician’s Letter of Agreement will display program.

Provider Enrollment (PE) License Renewal in Process Letter for LTC Provider Types

PE and Site Visit (SV) will now accept the License Renewal In Process Letter for provider types that receive licenses from Health and Human Services Commission Long-term Care (HHSC-LTC) with licenses that are expired or approaching expiration while their reenrollment or revalidation is in process.

The following provider types are included: Home & Community Support Services Agencies (Home Health & HCSSA); Assisted Living Facilities (ALFs); Day Activity and Health Services Facilities (DAHS); Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID); Skilled Nursing & Nursing Facilities (SNF/NF); Personal Assistance Services (PAS/PCS); Prescribed Pediatric Extended Care Centers (PPECC); Primary Home Care (PHC)/Family Care (FC)/Community Attendant Services (CAS); Program of All-Inclusive Care for the Elderly (PACE).

Maintenance – Add/Modify Performing Provider Request

If the performing provider program practice location that is selected from the “Select the Existing Program to Add” drop-down menu is enrolled in Medicare, the request will only allow the provider to select the group program locations related to the same Medicare association.

System Performance and Deficiency Improvements

TMHP continues to improve the user experience with system performance and deficiency updates throughout PEMS. The most recent deficiency updates include enhancements to the following sections in PEMS: Programs, Ownership/Controlling Interest, and Practice Location Information.

Error Message for Duplicate Enrollment

PEMS will display the error message “Unable to create the request” when there is a duplicate enrollment request for the same performing provider.

“Used On a Service and Program Details Record” Table Added

The Accounting/Billing page now includes a table showing the practice location and program information that the provider’s W-9 is applied to.

Ownership and Controlling Interest Page – “Select Person or Entity” Disabled

When the provider adds a new Owner/Creditor/Principal and saves the page, PEMS will disable the “Select Person or Entity” field. If the provider needs to modify the field, they should remove the previous Owner/Creditor/Principal form and add it again with the correct person or entity selection.

PEMS Portal Reminder

Accessing PEMS

Providers must have access to the internet to access PEMS and use up-to-date internet browsers for optimum performance of the PEMS portal. TMHP recommends the use of Google Chrome or Microsoft Edge, as legacy Microsoft browsers Internet Explorer and non-Chromium based Edge are no longer compatible with PEMS.

PEMS Instructional YouTube Videos

TMHP has developed a series of instructional how-to videos that detail the steps required to update provider enrollment records.

To view the completed series of instructional how-to videos, click here.

PEMS Multi-Factor Authentication for Electronic Funds Transfer (EFT) Updates

Effective April 15, 2023, additional verification is required for PEMS EFT (electronic fund transfer) changes. A personal identification number (PIN) sent to the email address on file will be needed to make any changes to EFT information. EFT change requests cannot be created within 30 calendar days after approval of a “Maintenance-Provider Information-Change Email” request.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.