Texas Medicaid Streamlines Physician Enrollment and Credentialing Via PEMS
By Phil West

Thanks to a new streamlined process starting May 30, physicians enrolling or reenrolling in Texas Medicaid via the state’s Provider Enrollment and Management System (PEMS) will also be able to use the system to submit managed care organization (MCO) credentialing information at the same time.  

PEMS enrollment is required for any physician seeking to provide Medicaid services in Texas. For years, the Texas Medical Association has made requests to the state’s Health and Human Services Commission (HHSC) for improvements, including other recent advocacy securing an extension for revalidation.  

The new credentialing option for physicians is a step toward addressing concerns TMA expressed in a Nov. 1 letter to HHSC, including enrollment being “time-consuming, cumbersome and confusing to even the most sophisticated practices and facilities.”  

“This has been a long time coming,” said Marcial Andres Oquendo Rincon, MD, incoming chair of TMA’s Council on Socioeconomics. “I'm happy that this is going to happen now.” 

With this change, he says the Texas Medicaid & Health Partnership (TMHP) is addressing what he characterized as “redundancies” and “a burden on health care providers who just want to be able to take these patients on Medicaid.”  

The new credentialing tab will be featured on the TMHP interface, according to a recent announcement. Though MCOs will retain their credentialing roles, physicians now have the option to initiate the credentialing process through PEMS. Physicians who prefer to keep enrolling and credentialing separate can still do so, as credentialing is not required to finalize Medicaid enrollment.  

Upon accessing the new credentialing tab in PEMS, physicians will be prompted to choose whether to credential as part of the enrollment process. With that option, users must complete the credentialing application in full before both the Medicaid enrollment application and credentialing request can be submitted.  

Previously, a physician would need to use PEMS to enroll or reenroll and then seek credentialing from each individual managed care organization providing Medicaid coverage for that physician’s patients.  

“The credentialing process involves verifying a health care provider's qualifications, background, and professional standing to ensure that they meet the standards required to deliver care,” TMHP states in its online guidance. Physicians looking to apply electronically through PEMS should be prepared with documents proving they meet qualification standards in the following categories:  

• Education; 

• Training; 

• Licensure;  

• Board certifications;  

• Work history; and 

• Academic background.  

“It's a tool to make our lives easier,” Dr. Oquendo said about the new streamlined onboarding process. “It's leveraging connectivity and technology to make our lives and the lives of our patients easier.”  

He encouraged physicians to use the new system once it goes live, urging patience given that it might have initial hiccups.  

“If you can, take advantage of the new process by having all your credentialing documents available so you can enroll and credential simultaneously,” advised Carra Benson, director of TMA’s Physician Payment Resource Center (PPRC). “At a minimum, go ahead and enroll, but having the ability to start the credentialing process will potentially save time on the lengthy process. 

“Since this is a new program and it might still have bugs, be sure to contact the PPRC should you run into any issues so we can help you troubleshoot them,” she added. 

Visit the PPRC to see what services are available for physicians seeking payment assistance.