Date: March 27, 2025
Attention: Providers
Subject: Provider Enrollment and Management System (PEMS) Reminders:
Certain Provider Types Must Enroll as an Individual and Dual Participating Providers Must Disclose Ownership Information
Call to action: The purpose of this communication is to serve as a reminder for two PEMS-related items, Certain Provider Types Must Enroll as an Individual and Dual Participating Providers Must Disclose Ownership Information to Both Programs (Medicare/Medicaid). This message is in accordance with guidance provided in the Texas Medicaid Provider Procedures Manual (TMPPM).
New PEMS Resource available: PEMS and Revalidation Information Video
How this impacts providers:
Certain provider types must enroll as an individual in PEMS.
- Individual enrollment applies to an individual health care professional who is licensed or certified in Texas and who is seeking enrollment under the name and Social Security number or tax identification number of the individual.
- An individual may also enroll as an employee, using the tax identification number of the employer.
The following provider types can enroll only as an individual:
- Dieticians
- Licensed vocational nurses (LVNs)
- Physical and occupational therapists
- Registered nurses
- Respiratory care practitioners
Source: Texas Medicaid Provider Procedures Manual (TMPPM), “Section 1: Provider Enrollment and Responsibilities,” subsection 1.1.4 “Provider Enrollment Identification will be updated with this information on April 1, 2025.
Dual Participating Providers Must Disclose Ownership Information to Both Programs
Providers that dually participate in Medicare and Medicaid must consistently disclose accurate ownership and managing staff information to each program per federal regulations § 420.202 through § 420.206.
Sources:
Next step for Providers: Providers must adhere to the guidance provided by TMPPM and outlined in this communication. For more information, view a new PEMS and Revalidation video available here. There is also the Provider Enrollment Requirements page with all of the resources listed.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts: https://www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts.
