Provider Enrollment Requirements
Providers are required to maintain current and accurate enrollment and demographic information in the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS).
PEMS is the required TMHP system and the single source of truth for provider enrollment and maintenance activities for Texas Medicaid, including:
- Enrollment, reenrollment, and revalidation
- Demographic and practice information updates
- Change of Ownership (CHOW) requests
Per guidance from HHSC and TMHP, Texas Children’s Health Plan (TCHP) requires providers to ensure their demographic information is aligned across the PEMS Master Provider File.
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. In addition, it is important that every provider be enrolled at each location where they see patients. This will help ensure claims process correctly and an accurate online provider directory for our Members seeking care.
To make updates to your current enrollment (e.g., new practice locations or change of ownership updates), please access Provider Enrollment on the Portal - A Step-by-Step Guide. Additionally, updates to provider’s current enrollment, new practice locations or change of ownership updates, can be made on the PEMS webpage. Otherwise, you can contact TMHP directly at 800-925-9126 for assistance.
Clinical Laboratory Improvement Amendments (CLIA) Certification
Providers that perform or bill for laboratory services must maintain a valid Clinical Laboratory Improvement Amendments (CLIA) certification in PEMS.
CLIA certification:
- Must be current and accurate in PEMS
- Must be appropriate for each laboratory procedure code billed
Claims submitted for laboratory services without the appropriate CLIA certification on file in PEMS may be flagged or denied in accordance with Texas Medicaid requirements.
Providers are strongly encouraged to:
- Regularly review CLIA information in PEMS
- Update CLIA certifications when adding new services or locations
- Ensure CLIA information is accurate during enrollment maintenance and revalidation
Helpful resources on PEMS:
