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IMPORTANT: HHSC Medicaid Provider Enrollment Revalidation Flexibilities

Date: 12/18/24

The Texas Health and Human Services Commission (HHSC) has provided information that Medicaid provider enrollment flexibilities have been initiated to ensure that eligible and/or currently enrolled Medicaid providers can continue to provide services for managed care Medicaid members and be reimbursed for the provision of services. Medicaid provider enrollment revalidation must be completed every three years to maintain active Medicaid enrollment status. For details of HHSC’s communication reference the Texas Medicaid & Healthcare Partnership's (TMHP) Revalidation Due Dates Extended and Retroactive Enrollment Period to be Implemented webpost.

Enrollment revalidation flexibilities include:

  • Closure of enrollment gaps for currently enrolled eligible Medicaid providers who were disenrolled for untimely revalidation between November 1, 2023, and December 12, 2024.
    • The provider’s enrollment period effective date will be backdated up to 365 days.
  • Additional 180 Calendar Days to complete Medicaid enrollment revalidation in the Provider Enrollment and Management System (PEMS) for providers whose revalidation date is between December 13, 2024, and May 31, 2025.

HHSC will be providing additional details soon. Superior HealthPlan acknowledges the challenges that some of our providers have experienced related to Medicaid revalidation through the THMP PEMS.

 Below are a few reminders for providers while we await additional details and provider enrollment updates:

  • Please ensure all claims are submitted to Superior as services are provided. Do not hold claims if you have experienced gaps in your Medicaid enrollment.
  • If you have not already done so, contact your Superior Account Manager if your claims have been denied for reason of untimely enrollment revalidation between November 1, 2023, and December 12, 2024.
  • Providers that have not yet begun the revalidation process should start as soon as possible.
    • Providers can start the revalidation process 180 Calendar Days prior to their revalidation due date. They can verify their revalidation due date on the Provider Information page in the PEMS.

For questions, please contact your local Account Manager. To access their contact information visit Find My Account Manager.