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Coming Soon: PEMS Update to Allow Provider Credentialing

Date: 04/17/25

Beginning May 30, 2025, the Provider Enrollment and Management System (PEMS) will streamline the process for Texas Medicaid enrollment and Managed Care Organization (MCO) credentialing. PEMS will feature a new Credentialing tab that will allow providers to complete and submit their credentialing information as part of the enrollment process, the re-enrollment process, or as a maintenance request.

While Superior HealthPlan and the Credentials Verification Organization (CVO) will maintain our credentialing roles, providers will initiate the credentialing process through PEMS. Although the credentialing application will be accessible in PEMS, it is optional. It is not required for enrollment, and it does not need to be completed to finalize the Medicaid enrollment application.

Additionally, a new Maintenance - Credentialing Information Request option will be available in PEMS for actively enrolled providers seeking to credential with an MCO. Providers may use this option to initiate and complete the credentialing process and to submit their credentialing information.

Providers should note the following:

  • If providers wish to credential with an MCO through PEMS, they must indicate "Yes" or "No" to attest before submitting their application.
    • If answering "Yes," they must proceed with the credentialing process concurrently with their enrollment application.
    • If they choose to submit the application concurrently, the credentialing application must be completed in its entirety before the Medicaid and credentialing application can be submitted.
  • Providers that are re-enrolling can complete their credentialing during re-enrollment.
  • While PEMS captures the credentialing information, the CVO will verify all information to ensure that it meets credentialing requirements. The CVO is responsible for receiving completed applications, attestations, and primary source verification documents.

Credentialing Requirements

The credentialing process involves verifying a health care provider’s qualification, background, and professional standing to ensure that they meet the standards required to deliver care.

Providers must:

  • Submit their application electronically through PEMS, including necessary documents such as proof of education, training, licensure, board certifications, work history, and academic background.
  • Enroll in PEMS before they can provide Medicaid services. New providers can complete their credentialing during their new enrollment application.

If you have questions about PEMS or the upcoming credentialing option, please contact the Texas Medicaid & Healthcare Partnership (TMHP) Contact Center at 1-800-925-9126 or by completing a TMHP Contact Us form.

For questions related to Superior, please contact your local Provider Representative. To access their information, visit the Find My Provider Representative webpage.