Updates and Directions in Preparation for Implementation of PEMS Master Provider File Regarding Address Differences

Date: September 9, 2024 

Attention: All Providers

Updated PEMS Go-Live Date: May 30, 2025

Call to action: Texas Children’s Health Plan (TCHP) 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. The providers with these mismatched addresses in our network will receive communication directly from TCHP. 

How this impacts providers: The communication from TCHP will include the following information: 

• Date providers must complete the address update
• TCHP follows the State of Texas Medicaid contract guidelines. Therefore, providers must maintain their enrollment information including address information for each practice location within PEMS
• “How to update the provider address in PEMS” YouTube video link
• TMHP contact center phone number is 800-925-9126 Option 3 if providers have any questions 

Providers that neglect to update their address information within the specified period will experience the following consequences: 

• Payment denial code will be applied by PEMS if the providers are not actively enrolled in PEMS
• TCHP will deny the claim for those providers not actively enrolled in PEMS as previously stated in a provider alert, click here for the communication.

TCHP along with all other MCOs must report completion metrics to HHSC to help measure the address synchronization between the MCOs and PEMS. The report will include: 

• Total number of providers with “Address discrepancy”
• The number of providers who performed the change
• Percentage of updates made successfully

Next step 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.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts,log into:
www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts or www.texaschildrenshealthplan.org/for-providers.