Date: March 3, 2025
Attention: All Providers
Effective date: February 21, 2025
Call to action: The purpose of this communication is to inform providers that effective February 21, 2025, updates were made to the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS).
Ability to Submit Maintenance Requests During the Revalidation Window
PEMS has been updated to allow users to submit license and surety bond maintenance requests during their revalidation window. This gives providers two options when they need to update their license or surety bond information when they are in their revalidation window:
- The provider may use the revalidation request type to submit their revalidation, including the updated license or surety bond information.
- The provider may use a maintenance request to update only their license or surety bond information.
PEMS will allow only one request at a time. If the provider creates a PEMS maintenance request within their revalidation window, the PEMS revalidation request will not be available if the PEMS maintenance request is in a draft status or still being processed. Similarly, if the provider has a PEMS revalidation request in draft or in progress, the PEMS maintenance request will not be available.
The following message will be displayed in PEMS to notify providers that submitting maintenance requests within their revalidation window may delay the revalidation process:
“You are within your 180-day revalidation window, and your maintenance request may delay your revalidation. A maintenance request can take up to 30 days to process, and you cannot begin to revalidate until your request has been approved. Consider submitting a revalidation request to include all necessary updates in one request type.”
Submission of Appropriate Request Types
PEMS will only allow providers to start a request type that is valid based on the provider’s enrollment status at the time they initiate the request. These changes will prevent a provider from submitting a request that is no longer valid based on the provider’s enrollment status at the time of submission.
- Providers who are disenrolled may submit the following request types:
- Reenrollment
- Maintenance - W9/Tax Information (Billing NPIs Only)
- Maintenance - Provider Information - Change Email
- Maintenance - EFT (Billing NPIs Only)
- Providers who are enrolled and within their revalidation window may submit the following request types:
- Revalidation
- Maintenance - Licenses
- Maintenance - Provider Information - Change Email
- Maintenance - Practice Location - Surety Bond (Billing NPIs Only)
- Providers who are enrolled and outside their revalidation window may submit the following request types:
- Existing Enrollment
- Maintenance - Provider Information
- Maintenance - Licenses
- Maintenance - W9/Tax Information (Billing NPIs Only)
- Maintenance - Ownership/Controlling Interest (Billing NPIs Only)
- Maintenance - Disclosure
- Maintenance - Attachments
- Maintenance - Provider Information - Change Email
- Maintenance - Practice Location - Demographics
- Maintenance - Practice Location - Address Change (Billing and Ordering Referring NPIs Only)
- Maintenance - EFT (Billing NPIs Only)
- Maintenance - Practice Location - Surety Bond (Billing NPIs Only)
- Add/Modify Performing Provider
- Maintenance - Practice Location - Attestations & Home Telemonitoring
When a provider tries to submit a request for a request type that does not align with their National Provider Identifier (NPI) enrollment status, the request will not save, and the following error message will display to explain the reason:
“The request that you are trying to submit is not appropriate for your enrollment status. Please cancel this request and select Edit Enrollment Record to create an appropriate request type. If you have any questions, call the TMHP Contact Center at 800-925-9126 and select option 3 for Provider Enrollment, or visit the PEMS Instructional Site for request type definitions.”
Next steps: Providers should share this communication with their staff.
Resources:
- Medicaid and CHIP Provider Enrollment and Revalidation: Enrollment Gap Flexibilities, Closures, & Claims Reprocessing: Provider Alert
- Preparation for Implementation of PEMS Master Provider File Regarding Enrollment and Address Information: Provider Alert
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
