Tag: Texas Medicaid & Healthcare Partnership (TMHP)
Superior HealthPlan Billing Changes
Important Provider Update
Effective September 1, 2025
The Texas Health and Human Services Commission (HHSC) will transition Medicaid-only services for dually eligible clients (eligible for both Medicare and Medicaid) from Fee-for-Service (FFS) to a Managed Care service delivery system.
Superior HealthPlan will be responsible for adjudicating these claims.
Provider Responsibilities
Submit claims for Medicaid-only services for dual eligible clients directly to the Managed Care Organization (MCO).
If a Claim is Sent to TMHP in Error:
TMHP will forward the claim to the correct MCO.
The TMHP response will only confirm forwarding – no ER&S report will be issued.
Claims with dates of service on or after Sept. 1, 2025 will not be adjudicated by TMHP.
Provider Action Steps
✅ Submit Medicaid-only service claims directly to the MCO.
✅ Contact the MCO for claim status and adjudication questions.
✅ Review the Rider 32 Procedure Code List (PDF) for impacted services.
✅ Reach out to your Provider Representative via the Find My Provider Representative webpage.
Need Help?
Contact your dedicated Provider Representative
TMHP, New Provider Enrollment Tool
Addressing physician concerns about online Medicaid enrollment challenges, the Texas Medicaid and Healthcare Partnership (TMHP) has announced its new Provider Enrollment Assistant Tool (PEAT) is available for enrollment-related help.
Users can navigate to the help page in TMHP’s provider enrollment section to access the tool, which TMHP describes as “question-based software.” Typing in a question prompts PEAT to provide:
- Answers to revalidation questions, including due dates;
- Online appointment scheduling for personalized support with enrollment issues, including step-by-step guidance from a TMHP representative;
- Information about Provider Enrollment and Management System (PEMS) maintenance requests; and
- Instructions for new enrollments, re-enrollments, and updates to existing enrollments.
Before initiating a PEAT request, TMHP advises having at the ready your National Provider Identifier (NPI), ZIP code, taxonomy number (if applicable), and any contact information related to the NPI.
In addition to a PEAT info sheet accessible online, TMHP is offering walk-through sessions for those needing additional enrollment support, which can be scheduled via PEAT, and offers an online PEMS guide updated in March.
HHSC Extends Medicaid PEMS Revalidation
~Phil West, TMA
Health and Human Services Commission (HHSC) has provided an extension for physicians due for revalidation between Dec. 13 and May 31 through Texas Medicaid & Health Partnership’s (TMHP’s) Provider Enrollment and Management System (PEMS).
While the extension grants an additional 180 days to physicians due for revalidation between those dates, TMA advises physicians who are due for revalidation over the next six months to file online with HHSC as soon as possible.
Have Questions About Capturing Telehealth Visits?
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The following is a list of guidelines provided by MGMA:
Click on the title to follow the link.
Medicaid and CHIP Program Revalidation
IMPORTANT:
During the Public Health Emergency (PHE), Provider
Revalidation was waived by HHSC.
The PHE ended May 11, 2023
Beginning May 12, 2023, Provider Revalidation Requirements were resumed.
Providers must ensure Medicaid and/or CHIP enrollment revalidation is completed on or before the provider’s scheduled revalidation date.
Providers that do not complete the revalidation process by their deadline are DISENROLLED from all Texas state healthcare programs, including Medicaid and/or CHIP managed care programs.
Visit the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment webpage to view and confirm your upcoming Medicaid and /or CHIP program revalidation date, verify current enrollment is active and verify all information in the PEMS system is accurate.
You have to revalidate your enrollment to stay in Medicaid.
If you are a physician participating in the Texas Medicaid program and saw your required revalidation period for the program extended due to the COVID-19 pandemic, take note:
The End Of That Extension Is Coming on February 28th, 2022.
Coming Soon: PEMS
Coming Soon: TMHP Provider Enrollment and Management System (PEMS)
Providers should plan for the following changes on December 13, 2021:
- PEMS will replace Provider Enrollment on the Portal (PEP) and the Provider Information Management System (PIMS).
- PEP and PIMS will no longer be available.
- Paper applications for Texas Medicaid provider enrollment will be eliminated with the new online system.
- Providers must have access to the internet to utilize PEMS and use up-to-date internet browsers for optimum performance of the PEMS portal. Use Google Chrome or Microsoft Edge to reduce compatibility issues
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