Action Required: Complete Revalidation in PEMS to Avoid Disenrollment and Claim Denials
Date: August 5, 2026
Attention: All Providers
Important Reminder for All Providers
Texas Children's Health Plan (TCHP) reminds all Medicaid-enrolled providers to complete revalidation through the Provider Enrollment and Management System (PEMS) by their assigned due date to remain actively enrolled and eligible for Medicaid reimbursement.
Providers may begin the revalidation process up to 180 days (6 months) before their revalidation due date. Starting early can help prevent delays, deficiencies, claim denials, or disenrollment.
Why Revalidation Is Critical
Providers who do not complete revalidation on time may experience:
- Disenrollment from Texas Medicaid
- Nonpayment for services rendered to Medicaid members
- Requirement to re-enroll, with no retroactive payment for services provided while disenrolled
What Providers Should Do Now
- Log in to PEMS
- Confirm your revalidation due date
- Check your application status (not started, draft, or pending response)
- Start or continue your revalidation application
- Complete all required sections
- Upload requested documentation
- Respond promptly to any deficiency or follow-up requests
- Ensure your application reaches a “Closed-Enrolled” status by your due date
How Revalidation Status May Impact Claims Payment
Claims may be denied if a provider fails to complete revalidation by the required due date. Providers should review their PEMS revalidation status and take prompt action to avoid interruptions in payment.
Revalidation Appeal Process (After Disenrollment)
To resolve claim denials related to revalidation status, providers should:
- Contact TMHP to initiate an appeal of their PEMS revalidation/disenrollment status
- Follow TMHP instructions and submit all required documentation
- Request revalidation within 60 days of original revalidation due date
If the extension is approved and enrollment is restored:
- The State will remove the applicable disenrollment code and TCHP will reprocess automatically
Important Reminders
- A revalidation request is not complete until it reaches “Closed-Enrolled” status in PEMS
- Providers should begin revalidation early and respond promptly to requests
- Failure to complete revalidation in a timely manner may result in disenrollment and claim denials
PEMS Revalidation and Reenrollment Resources
Providers may refer to the PEMS educational videos on TMHP’s Provider Enrollment & Management System YouTube playlist, which includes the following:
- Revalidating an Individual
- Revalidating a Performing Provider
- Revalidating a Clinic/Group Practice or Facility
The following resources provide more information about Medicaid provider revalidation requirements and common deficiencies to avoid:
- Common Deficiencies Identified by the Office of Inspector General (OIG)
- Affordable Care Act (ACA) Screening Requirements
Need Assistance?
For questions related to revalidation status or to initiate a request to restart revalidation, providers must contact TMHP:
- Phone: TMHP Contact Center at 800-925-9126
If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.
For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts