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Texas Medicaid Provider Enrollment: TMHP Enrollment Done Right
PEMS Applications, Revalidation and Medicaid Health Plan Credentialing
To bill Texas Medicaid or CHIP, a provider must first enroll with the Texas Medicaid & Healthcare Partnership (TMHP) and then join the Medicaid health plans that cover their patients. Billing Benefit prepares and submits your TMHP application, answers TMHP’s requests and then gets you credentialed with the STAR and CHIP plans, so you can see and bill Medicaid patients.
Texas Medicaid Enrollment Problems We Fix
| Enrollment problem | Why it costs you | How we fix it |
|---|---|---|
| Application sent back or denied | Missing ownership disclosures, an NPI, taxonomy or license that does not match, or an unsigned form sends the application back and restarts the wait. | We check every field against your NPI, license and ownership records before we submit, and answer TMHP’s requests quickly. |
| Enrolled with TMHP but not with the plans | Most Texas Medicaid and CHIP patients are in managed care plans (STAR, STAR+PLUS, STAR Kids and CHIP), and each plan credentials and contracts with you separately. | We apply to the plans that cover your patients and follow up until you are in network. |
| Missed revalidation | Texas Medicaid providers must revalidate their enrollment at least every five years. A missed deadline can end your enrollment and stop payment. | We track your revalidation date and submit well before it is due. |
| Ordering and referring providers not enrolled | Claims for labs, imaging, equipment and referrals can be denied when the ordering or referring provider is not enrolled in Texas Medicaid. | We enroll ordering and referring providers too, so their orders do not cause denials. |
| Practice changes not reported | A new address, tax ID, owner or provider must be reported to TMHP. Unreported changes lead to denied claims and held payments. | We file the change requests whenever your practice changes, so your enrollment stays current. |
What Texas Medicaid Enrollment Involves
TMHP, PEMS and the Medicaid health plans
TMHP handles provider enrollment for Texas Health and Human Services (HHSC). Applications are filed online in PEMS, the Provider Enrollment and Management System, with your NPI, Texas license, taxonomy, ownership and disclosure details. Some provider types also need fingerprint-based background checks or pay an application fee. After TMHP approves you, each STAR, STAR+PLUS, STAR Kids and CHIP plan credentials you separately before you join its network.
How We Handle Your Medicaid Enrollment
From application to first paid claim
We collect your documents once, set up or update your CAQH ProView profile, prepare the PEMS application and respond to TMHP’s requests. Once you are enrolled, we apply to the Medicaid health plans in your area and follow each application until it is approved, keeping you updated along the way.
Providers We Enroll in Texas Medicaid
Individual providers, groups and facilities
We enroll physicians, nurse practitioners, physician assistants, therapists and behavioral health providers, as well as group practices, clinics and facilities. We also add new providers to existing groups and enroll ordering and referring providers. For other payers, see our Medicare enrollment services, BCBS Texas credentialing and medical credentialing services.
Why Texas Practices Choose Billing Benefit
A Texas team that works with TMHP every day
We are based in Sugar Land and handle Texas Medicaid from enrollment to billing and coding and denial management. Facilities can also see our payer enrollment and facility credentialing services, and every practice can start with a free medical billing audit.
Texas Medicaid Enrollment FAQs
How long does Texas Medicaid enrollment take?
It depends on the provider type and how complete the application is. A complete, accurate application moves fastest; missing information or extra screening adds time. Health plan credentialing comes after TMHP approval and adds its own time, so it pays to start early.
Do I need to enroll with TMHP if I only see managed care patients?
Yes. Providers must be enrolled in Texas Medicaid through TMHP before a STAR or CHIP health plan can contract with them.
How often do I need to revalidate?
At least every five years, or sooner if TMHP asks. We track the date for you and submit before it is due.
Can you also bill our Medicaid claims?
Yes. Once you are enrolled, we can bill Texas Medicaid and the Medicaid health plans for you. See our medical billing and coding services.
Not Sure Where Your Revenue Is Leaking?
Get a free, no-obligation medical billing audit. We review your claims, denials and A/R, then show you what to fix first.
