Cold and flu season Temporada de influenza y resfriados

ALERT: Stay healthy this cold and flu season! Learn more

ALERTA: ¡Mantente sano durante esta temporada de influenza y resfriados! Más información

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Provider Enrollment Requirements

Providers must update their enrollment and demographic information with Texas Medicaid Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS). PEMS is the required TMHP program which is the single source of truth for provider enrollment, reenrollment, revalidation, change of ownership, and maintenance requests (maintaining and updating provider enrollment record information) for Texas Medicaid.

Per guidance from HHSC and TMHP, Texas Children’s Health Plan (TCHP) will require providers to ensure their demographic information is aligned across the PEMS Master Provider File effective May 30, 2025. TCHP will contract, credential and pay only those providers who are properly enrolled with TMHP and whose information is received in the official PEMS file from TMHP. In addition, it is important that every provider be enrolled at each location where they see patients. This will help ensure claims process correctly and an accurate online provider directory for our Members seeking care.

To make updates to your current enrollment (e.g., new practice locations or change of ownership updates), please access Provider Enrollment on the Portal - A Step-by-Step Guide. Additionally, updates to provider’s current enrollment, new practice locations or change of ownership updates, can be made on the PEMS webpage. Otherwise, you can contact TMHP directly at 800-925-9126 for assistance.

Helpful resources on PEMS:

Revalidation Information for Providers

HHSC is implementing provider enrollment revalidation flexibilities due to the significant challenges Medicaid providers are experiencing in complying with enrollment revalidation timelines and requiring all Medicaid and CHIP MCOs like TCHP to support these flexibilities. HHSC will extend revalidation due dates, and reduce or eliminate enrollment gaps, and require payers like TCHP to support claims reprocessing efforts. To learn more, view Medicaid and CHIP Provider Enrollment and Revalidation: Enrollment Gap Flexibilities, Closures, & Claims Reprocessing.

Revalidation resources: