Date: April 10, 2025
Attention: All Providers
Update as of May 7, 2025: The Texas Health and Human Services Commission (HHSC) has postponed the planned update only to the portion of the Provider Enrollment and Management System (PEMS) that would enable provider credentialing (PEMS+).
This functionality will be added later in 2025. More information will be published on tmhp.com when it becomes available.
Call to action: The purpose of this communication is to remind providers about the Provider Enrollment and Management System (PEMS) go-live May 30, 2025 and share an update on provider credentialing. PEMS will be enhanced to streamline the process for Texas Medicaid enrollment and managed care organization (MCO) credentialing. The new feature will allow a provider to complete and submit their credentialing information as part of the enrollment process, the reenrollment process, or as a maintenance request.
PEMS Enhancements
PEMS will feature a new Credentialing Tab for the credentialing application. While the MCO and the credentials verification organization (CVO) will maintain their credentialing roles, providers will now initiate the credentialing process through PEMS. Although the credentialing application will be accessible in PEMS, it is optional and not required for enrollment, and it does not need to be completed to finalize the Medicaid enrollment application.
- Providers must indicate "Yes" or "No" to attest if they wish to credential with an MCO before submitting their application.
- If answering "Yes," they must proceed with the credentialing process concurrently with their enrollment application. If they choose to submit the application concurrently, the credentialing application must be completed in its entirety before the Medicaid and credentialing application can be submitted.
- Providers that are reenrolling can complete their credentialing during reenrollment.
Note: While PEMS captures the credentialing information, the CVO will verify all information to ensure that it meets credentialing requirements. The CVO is responsible for receiving completed applications, attestations, and primary source verification documents.
Additionally, a new Maintenance - Credentialing Information Request option will be available for enrolled providers seeking to credential with an MCO.
Credentialing Requirements
The credentialing process involves verifying a health care provider's qualifications, background, and professional standing to ensure that they meet the standards required to deliver care.
Providers must:
- Submit their application electronically through PEMS, including necessary documents such as proof of education, training, licensure, board certifications, work history, and academic background.
- Enroll in PEMS before they can provide Medicaid services. New providers can complete their credentialing during their new enrollment application.
Providers that are actively enrolled in PEMS can use the Maintenance Request to initiate and complete the credentialing process and to submit their credentialing information.
Helpful resources on PEMS:
Next steps: Providers should share this communication with their staff.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.texaschildrenshealthplan.org/provideralerts.
