Preparation for Implementation of PEMS Master Provider File Regarding Enrollment and Address Information

Date: February 6, 2025

Attention: All Providers

PEMS Go-Live Date: May 30, 2025

Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers that the effective date for Provider Enrollment and Management System (PEMS) is May 30, 2025.

How this impacts providers: Providers that neglect to review and update their overall enrollment information and 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 overall enrollment information and 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: 
www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts