Medicaid and CHIP Enrollment and Revalidation

Medicaid Provider Enrollment

All providers that want to participate in state health-care programs must enroll in Texas Medicaid. This enrollment requirement applies to providers who participate in:

  • Traditional fee-for-service Medicaid
  • Long term-care services
  • Pharmacy services
  • Medicaid managed care
  • Ordering- and referring-only providers

To begin the enrollment, visit the TMHP How to Apply for Enrollment page. All providers will use the Provider Enrollment and Management System (PEMS) to complete the enrollment process.

Resources for enrollment:

Additional Steps for LTC-only Billing Medicaid Providers

Certain types of providers must take additional steps to contract with HHSC after enrolling with Texas Medicaid such as mailing a copy of their notification letter as proof of enrollment and other required documentation.

This includes nursing facilities, intermediate care facilities (ICF/IID), Programs of All-Inclusive Care (PACE) providers and waiver and community services program providers.

Visit this page for detailed information on this process and specific contact information.

Managed Care Contracting and Credentialing

Medicaid providers, including pharmacies, who want to contract with a medical or dental managed care plan must contact the managed care organization (MCO) of their choice to complete a separate contract and credentialing application in addition to enrolling through PEMS.

Visit the Managed Care Organization & Dental Maintenance Organization Provider Services Contact Information webpage for contacts.

Medicaid Provider Revalidation

The Affordable Care Act (ACA) requires Medicaid providers that enroll in state Medicaid programs to periodically revalidate their enrollment at least every five years.

Certain providers may be required to revalidate more often based on risk. The revalidation must be submitted electronically PEMS.

PEMS revalidation is when a provider submits a revalidation application for a Provider/National Provider Identifier (NPI) that has an existing enrollment record in PEMS prior to the end of their enrollment period without an enrollment gap. Providers should submit their revalidation applications at least 120 days before the end of their enrollment period so that the revalidation process can be completed before the enrollment period ends.

Providers who do not submit the revalidation application by the revalidation due date must submit a re-enrollment application.

Resources for revalidation: