To help manage a backlog stemming from the transition to Medicaid’s new Provider Enrollment Management System (PEMS), the state’s Medicaid claims payment contractor announced it will extend reenrollment, or revalidation, time frames for physicians and other health care practitioners and suspend disenrollments related to that process.
Meanwhile, the Texas Medical Association is working to resolve other issues related to the new PEMS system, which launched in December 2021.
According to the Texas Medicaid & Healthcare Partnership (TMHP), physicians and others who were due to re-up their enrollment between March 1, 2020, and Nov. 30, 2022, will receive a grace period after the end of the COVID-19 public health emergency to complete their revalidation. TMHP will notify practitioners in August 2022 of their recalculated enrollment end date and again 120 days prior to their enrollment end date.
If you have a revalidation application in progress, you will be allowed to continue and receive your next revalidation due date based on the application results. Those without applications in progress will be eligible to submit them 120 days prior to their recalculated due date. If you wish to submit for revalidation earlier than that, email a request to provider.relations@tmhp.com for assistance.
“Providers who were disenrolled due to failure to revalidate will be reactivated, and claims will be reprocessed based on the recalculated revalidation due date,” according to TMHP.
In addition, at TMA’s request, TMHP and Texas Medicaid have formed a workgroup of practice administrators to help address other outstanding PEMS-related enrollment issues. TMA will host an informal town hall with updates about PEMS changes in the coming weeks. Read Texas Medicine Today for updates.
Last Updated On
August 09, 2022
Originally Published On
August 08, 2022
Amy Lynn Sorrel
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