September 4th, 2023
VERY IMPORTANT: Provider Enrollment Revalidation Requirements
Provider Enrollment Revalidation Requirements https://www.tmhp.com/news/2023-09-01-reminder-provider-enrollment-revalidation-requirements
Providers must complete their revalidation enrollment before the end of their enrollment period. Providers can revalidate their enrollment in the Provider Enrollment and Management System (PEMS) up to 120 calendar days before their current revalidation due date.
Providers who do not complete the revalidation process by their deadline will be disenrolled from all Texas state healthcare programs, and claims and prior authorization requests will be denied.
Providers may find more information and begin their revalidations in PEMS through the tmhp.com website at tmhp.com/topics/provider-enrollment/how-apply-enrollment under “Determine Your Application Type.”
For more information, call the TMHP Contact Center at 800-925-9126.
Revalidating providers may need to provide fingerprints, submit additional documentation, or complete other screening requirements.
Providers may view and confirm their revalidation date and enrollment information in PEMS. To reduce application time, we encourage providers to have the following information available:
- First and last name
- Organization name
- Social Security number
- Date of birth
- Employer’s Tax Identification Number and legal name
- Licenses or certifications, if applicable
- Identification for the provider and any person who meets the definition of owner, creditor, principal, subcontractor, or managing employee
- Documentation related to disclosures, if needed
- Additional documentation required for program participation
Providers revalidating an existing enrollment should continue to submit claims to meet their timely filing requirements.
Certain revalidating providers must pay an application fee. Please see: State of Texas Provider Types Required to Pay an Application Fee to determine which type of providers must pay the provider enrollment application fee and for additional information, please look at the Texas Medicaid Provider Procedures Manual, Vol. 1, Provider Enrollment and Responsibilities