Important Update Actualización importante:

Good news! All CHIP, STAR, and STAR Kids Member Handbooks are now available online. Quick, easy access to your benefits and coverage information - any time!

¡Buenas noticias! Todos los manuales para miembros de CHIP, STAR y STAR Kids ya están disponibles en línea. Obtén acceso rápido y sencillo a la información sobre tus beneficios y cobertura, ¡en cualquier momento!

Medicaid Preferred Drug List and Formulary Changes Cambios en el formulario y la lista de medicamentos preferidos de Medicaid

The Vendor Drug Program (VDP) made changes to the Texas Medicaid drug formulary effective July 24, 2026. To learn more about formulary changes impacted, please click here for more information.

El programa de medicamentos de proveedores de Texas (VDP) ha realizado cambios recientes en el formulario de medicamentos de Medicaid de Texas. Esto entrará en vigencia el 24 de julio de 2026. Para obtener más información sobre los cambios en el formulario afectados, visite el siguiente enlace para obtener más información.

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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