Provider Enrollment Revalidation Extensions to End on May 11, 2023

Date: 03/13/23

The Affordable Care Act (ACA) requires that Medicaid providers enroll in state Medicaid programs and then periodically revalidate their Medicaid enrollment at least every five years; however, certain providers may be required to revalidate more often based on risk level. Due to the federal COVID-19 public health emergency (PHE) and in alignment with federal guidelines, Texas Health and Human Services Commission (HHSC) allowed Medicaid providers to delay their revalidation requirements. To operationally accommodate this flexibility, HHSC instructed the Texas Medicaid & Healthcare Partnership (TMHP) to extend revalidation due dates for Medicaid providers.

HHSC will end the flexibility of extended Medicaid provider revalidation dates that came due during the COVID-19 PHE effective May 11, 2023. Per federal guidance, providers that were due for revalidation effective March 1, 2020, through May 11, 2023, will receive a post-PHE grace period to complete the revalidation process. TMHP will notify providers in March 2023 of their recalculated enrollment end date and again 120 days prior to their Medicaid provider enrollment end date. Providers are strongly encouraged to avoid potential enrollment delays by submitting revalidation applications as soon as possible within the 120-day window.

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. Revalidating providers may need to provide fingerprints, submit additional documentation, or complete other screening requirements.

Providers can visit TMHP’s Provider Enrollment and Management System (PEMS,) to view and confirm their revalidation date and enrollment information. To speed up the application process, providers should have the following information available to ensure this information is accurate:

• First and last name
• Organization name
• Social Security number
• Date of birth
• Employer’s tax identification number and legal name
• Licenses or certifications, if applicable
• Identification for the provider and any person who meets the definition of owner, creditor, principal, subcontractor, or managing employee
• Documentation related to disclosures, if needed
• Additional documentation required for program participation

Providers that are revalidating an existing enrollment should continue to submit claims to meet their timely filing requirements while their revalidation is being processed. Certain revalidating providers must pay a provider enrollment application fee. For a list of institutional providers that have to pay the application fee, please refer to the TMHP State of Texas Provider Types Required to Pay an Application Fee reference guideExternal Link.

For more information, please refer to the General Information, Section 1, “Provider Enrollment and Responsibilities” in the current Texas Medicaid Provider Procedures ManualExternal Link.

For more information about  the revalidation process please visit the "Determine Your Application Type" section of the TMHP Provider Enrollment and Management System (PEMS) webpageExternal Link.

For further assistance, call the TMHP Contact Center at 800-925-9126 or email: providerenrollmentmanagementsystem@hhs.texas.gov