Provider Alert! Provider Enrollment Revalidation Extensions to End on May 11, 2023
Date: May 2, 2023
Attention: All Providers
Call to action: Texas Children’s Health Plan would like to remind providers that effective May 11, 2023, the Health and Human Services Commission (HHSC) will end the flexibility of extended Medicaid provider revalidation dates that came due during the COVID-19 public health emergency (PHE). Additional information:
- Per federal guidance, providers that were due for revalidation effective March 1, 2020, through May 11, 2023, will receive a post-PHPHE grace period to complete the revalidation process.
- Texas Medicaid and Healthcare Partnership (TMHP) notified providers in March 2023 of their recalculated enrollment end date and will notify them again 120 days prior to their Medicaid provider enrollment end date.
- Providers can find their revalidation due dates in the Provider Dashboard in the Provider Enrollment and Management System (PEMS) under the Revalidation Due Date field in the Enrollment Information section of the Provider Information page. Click here for a link to the PEMS webpage.
- As you may recall, the PEMS effective date was delayed to June 30, 2023. Therefore, considering the end date of May 11, 2023, for the provider enrollment revalidation extension TCHP recommends that providers ensure their information is updated on both Master Provider File (MPF) and PEMS. This will reduce errors in provider data and will ensure that provider information is correct on both files. Provider enrollment webpage is available by clicking here.
Accordingly, as an MCO, TCHP will contract, credential and pay only those providers who are properly enrolled with TMHP and whose information is received in the official MPF/PEMS file from TMHP. In addition, it is important that every provider be enrolled at each location where they see patients. This is to help ensure claims process correctly.
How this impacts providers: Providers that do not complete the revalidation process by their deadline will be disenrolled from all Texas state health care programs, and all claims and prior authorization requests submitted after the revalidation deadline will be denied.
Next steps for providers: Providers should monitor their revalidation due date and plan accordingly to complete the process ahead of schedule.
Providers are advised to review communication previously published from TCHP on this topic here: http://www.thecheckup.org/2023/04/27/provider-alert-update-provider-enrollment-and-management-system-pems-provider-guidance-3/
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
