At Community First Health Plans, we are dedicated to assisting you in becoming one of the many Texas Providers who support the health of low-income Texans.
All providers must be enrolled in Texas Medicaid before enrollment can be approved for any other service or program, including, but not limited to, Medicaid managed care. Providers must maintain a valid, current license or certification to be entitled to Texas Medicaid reimbursement. Providers cannot enroll in Texas Medicaid if their license or certification is due to expire within 30 days of application. A current license or certification must be submitted, if applicable.
To remain in compliance with Title 42 Code of Federal Regulations §455.414, providers must complete the revalidation process before the end of their enrollment period, which is also called the “revalidation date.” If a provider’s enrollment period ends before TMHP has received the provider’s revalidation application, TMHP automatically disenrolls providers on the date that their enrollment period ends. Providers can view and confirm their revalidation date and enrollment information by logging into PEMS. Most providers have an enrollment period of 5 years. Some providers have shorter enrollment periods, which are based on risk categories and other considerations. Providers can only submit the revalidation application online through PEMS.
If providers do not complete the revalidation process before the end of their enrollment period, they will be disenrolled. Their claims will not be paid, and their prior authorization requests will be denied. They will not be eligible to participate as a network provider in Medicaid MCOs.
If additions or changes occur in a provider/group’s enrollment information (for example, a performing provider leaves or enters the group, changes the physical address or the accounting/mailing address, or a provider is no longer licensed) after the enrollment process is completed, the provider group must notify Texas Medicaid in writing within 90 calendar days of occurrence of the changes. Failure to provide this information may lead to administrative action by HHSC. Filing claims and receiving payment without having followed this requirement constitutes a program violation and may also result in administrative, civil, or criminal liability.
The following are various enrollment assistance options provided by the Texas Medicaid & Healthcare Partnership (TMHP), which include:
- Online enrollment through the Provider Enrollment and Management System (PEMS)
- Customized online instructions for every Provider type
- Enrollment training
- Guides and FAQs
- Provider Enrollment coordinators
Video Tutorials and Demos:
A set of videos that outlines Provider enrollment tasks in PEMS has been produced by TMHP. These videos can be accessed on the TMHP YouTube Channel and include the following:
- Creating a Secure Account
- Start New Enrollment
- Resolving Deficiencies
- Navigating PEMS
- Adding Attachments
- Signing Agreements
- PEMS CHOW
- PEMS LTC Video
- Taxonomies and Enrollment
- Add Performing Providers
- Add Practice Locations
- Address System Deficiencies
- Cancel a Request
- Disenroll a Provider
- Submit an EFT Request
- Update an Existing Address
- Update License Information
- Registering as an Individual Transportation Participant (ITP)
Information about PEMS, as well as the distinctions between PEMS and prior enrollment systems, can be found at the following location:
Provider Enrollment Training Modules:
Through its Learning Management System (LMS) server, TMHP provides numerous computer-based training (CBT) modules and recorded webinars. The following CBTs are particularly useful during the enrollment process:
- Provider Enrollment and Management System (PEMS)
- Medicaid Basics
- Durable Medical Equipment (DME)
- THSteps Medical and Dental Services
- CSHCN Services Program Basics
- Medical Transportation Program (MTP)
Important: To view a CBT, you must be registered on the LMS.
Helpful Guides and FAQs:
Below are supplementary guides and FAQs that may be valuable to you as you navigate the enrollment process:
- Medicaid Surety Bonds for Ambulance Providers
- Provider Fingerprinting Requirement FAQs
- PEMS Provider Webinar Question and Answer
- A Quick Start Guide to Using PEMS
- PEMS Best Practices Guide
- PEMS Instructions for HTW Certification and Attestation
- ACA Screening Requirements
Additional Support Services:
TMHP has a specialized team that provides education and training to Providers on the application process and requirements for TMHP Provider enrollment. Additionally, they offer hands-on assistance with completing and submitting the TMHP enrollment application.
If you require further guidance with the enrollment process, please reach out to the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413. You may also send an email to firstname.lastname@example.org to request assistance with any enrollment-related inquiries.
Community First Resources:
Contact: Email ProviderRelations@cfhp.com or call 210-358-6294