Ensure Your Information Is Current: Provider Enrollment Management System (PEMS) & Revalidation

Date: April 30, 2025

Attention: All Providers

Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers to update their provider profile in the Provider Enrollment Management System (PEMS) by May 30, 2025. Don’t wait – ensure your information is current to avoid any disruptions to your operations.

As per guidance from the Texas Health and Human Services Commission (HHSC) and the Texas Medicaid & Healthcare Partnership (TMHP), TCHP will require all providers to ensure their information is aligned across the Provider Enrollment and Management System (PEMS) effective May 30, 2025.

• PEMS is the official source of truth for all provider information.
• TCHP will contract, credential and pay only those providers who are properly enrolled with TMHP and whose information is received in the official PEMS file from TMHP.
• It is essential for every provider to be enrolled at each location where they see patients. This will help ensure an accurate online directory with correct search results.

Retroactive Enrollment and Claims Reprocessing Action Required

In response to the challenges Medicaid providers are facing in meeting enrollment revalidation timelines,

HHSC and TMHP are implementing provider enrollment revalidation flexibilities to ease the process. As part of this effort, TMHP will:

• Extend revalidation due dates and reduce enrollment gaps.
• Support claims reprocessing for impacted providers.

PEMS and Revalidation Overview (video)

This presentation provides updates on the following:

• Updates regarding the PEMS Master Provider File effective May 30, 2025
• Benefits of PEMS and how it is accessed
• Key next steps for providers
• Revalidation due dates
• Claims reprocessing information
• Helpful resources to assist you in the process

You can access the presentation here.

Next step for Providers: We encourage providers to view the presentation and stay informed about these changes for ensuring smooth participation in PEMS and adhere to revalidation requirements. For more information on PEMS and Revalidation, view our Provider Enrollment Requirements page.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.