Effective December 13, 2024, providers will receive an additional 180 calendar days to complete revalidations in the Provider Enrollment and Management System (PEMS). Additionally, the Texas Medicaid and Healthcare Partnership (TMHP) and the Texas Health and Human Services Commission (HHSC) are developing a process to address enrollment gaps for providers that have been disenrolled for failing to revalidate timely. These flexibilities are currently planned to last through May 31, 2025.

Providers who have started the revalidation or reenrollment process should continue to work on their applications and complete them as soon as possible to minimize any delays or challenges. For providers that have not yet begun the revalidation process, TMHP recommends starting the process as soon as possible. The revalidation process becomes available to providers 180 calendar days prior to their revalidation due date. Providers can check their revalidation due date on the Provider Information page in PEMS.

Revalidation Due Date Extensions

Providers that are due for revalidation between December 13, 2024, and May 31, 2025, will receive an additional 180 calendar days to complete their revalidation. PEMS will check daily for all providers that are due for revalidation the following calendar day, and if the provider has not completed revalidation*, PEMS will automatically add 180 calendar days to the revalidation due date. This will be reflected in the Revalidation Due Dates found on the Provider Information page in PEMS. Providers will also receive an email notification with their new revalidation due date. This extension will allow providers additional time to submit and complete PEMS revalidation requests and prevent disenrollment.

*Important: A provider has not completed revalidation until their revalidation request is “closed-enrolled.” Submission of a revalidation request is the first step of the process. The revalidation request must then be reviewed and approved by TMHP, and the request status must be “closed-enrolled” for revalidation to be considered complete.

Retroactive Enrollment Period Effective Dates

TMHP and HHSC are developing a process to modify enrollment period effective dates for providers that:

• Have been disenrolled for failing to revalidate timely between November 1, 2023, and December 12, 2024.
• Successfully reenroll in Texas Medicaid.

For providers that meet both of these criteria, the provider’s enrollment period effective date will be backdated up to 365 days to reduce or eliminate their enrollment gap.

TMHP and HHSC expect this process to be implemented in early 2025 and will provide additional information and timelines when available.

Claims Filing

HHSC is working with TMHP and managed care organizations (MCOs) to provide additional guidance on claims filing in relation to retroactive enrollment period effective dates. Additional details will be shared with providers in an upcoming communication.

For more information, call the TMHP Contact Center at 800-925-9126.