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Texas Medicaid Provider Enrollment Through TMHP and PEMS, Explained
Enrollments are billed 50% at the start and 50% at submission; everything else 100% at the start.
- Flat PricesNo percentage of collections
- Half Now, Half at SubmissionFor every enrollment application
- Closed Network?Your choice of a refund or a credit
- Live Status TrackingCheck any application by reference number
Texas Medicaid is run by the Texas Health and Human Services Commission (HHSC), and the Texas Medicaid & Healthcare Partnership (TMHP) handles provider enrollment for the state. Getting paid for Texas Medicaid members takes two separate things: an enrollment with Texas Medicaid through TMHP's online Provider Enrollment and Management System (PEMS), and a credentialed contract with each managed care organization whose members you want to see. This guide explains both, the screening rules that decide how long the state step takes, and how Texas centralizes MCO credentialing.
Two Layers: State Enrollment and MCO Credentialing
The state layer is enrollment. Every provider who participates in traditional fee-for-service Medicaid, long-term care, pharmacy services, Medicaid managed care, or as an ordering and referring only provider must enroll through PEMS. Enrollment establishes that you are licensed, screened and eligible to be paid by Texas Medicaid.
The plan layer is credentialing and contracting. Most Texas Medicaid members are enrolled in a health plan through STAR, STAR+PLUS, STAR Kids, STAR Health or CHIP, and HHSC tells providers who want to join a plan to contact that MCO and complete a separate contract and credentialing application. The Medicaid enrollment does not put you in any plan's network.
The two layers are linked in one direction. TMHP states that all providers must be enrolled in Texas Medicaid before enrollment can be approved for any other service or program, and that to be reimbursed for managed care clients a provider must enroll in Texas Medicaid first and then with the client's health plan. File in PEMS first, and start the MCO applications as soon as the enrollment is approved.
The PEMS Enrollment Application
PEMS is paperless: one online application covers all programs and shows status as the application moves. Enrollment is tied to your NPI, so the NPI must exist in NPPES first. For most practitioners the application covers:
- Provider identity, NPI, Texas license and the practice locations you will bill from
- Owner, creditor and principal entries for every person with an ownership or control interest, with exceptions for performing providers joining an already enrolled group and individuals enrolling under their own Social Security number
- Supporting documents required for your provider type, attached to the application
- For groups, the group's own enrollment plus a performing provider enrollment for each practitioner
You can edit a submitted application in PEMS to correct deficiencies. TMHP gives you 30 business days to supply missing information, and if it is not provided, TMHP terminates the application and a new one must be filed. The TMHP Contact Center is at 1-800-925-9126. Individual practitioners who only order or refer for Texas Medicaid clients must also enroll, though practitioners who are in network with a Texas Medicaid MCO are exempt from that separate requirement.
Application Fees
Individual physicians and non-physician practitioners do not pay an application fee to enroll in Texas Medicaid. Institutional providers pay the federal provider enrollment application fee set by CMS each year, at initial enrollment, new practice locations, revalidation and reenrollment. For calendar year 2026 that fee is $750, up from $730 in 2025. TMHP cannot process an application when a required fee is missing. A provider that has already paid the fee to Medicare or another state's Medicaid program or CHIP can submit proof of that payment rather than paying twice.
Risk Levels: Site Visits and Fingerprinting
Federal Medicaid rules at 42 CFR Part 455 require each state to screen providers according to a risk level assigned by provider type. TMHP screens every provider by categorical risk level at initial enrollment, revalidation, enrollment updates and reenrollment, and you can see your assigned category in PEMS.
| Risk Level | Typical Provider Types | Screening |
|---|---|---|
| Limited | Physicians, nurse practitioners, therapists, psychologists, LCSWs, group practices | License verification and federal and state database checks before and after enrollment |
| Moderate | Several agency and supplier types designated by CMS | Everything in limited, plus a site visit at the practice locations on the application |
| High | Newly enrolling home health agencies and DME suppliers, plus providers raised to high risk | Everything in moderate, plus fingerprint-based criminal background checks of the provider and every owner with a 5 percent or greater direct or indirect interest |
For site visits, TMHP can rely on a Medicare site visit when the name, NPI or tax ID, practice addresses and owners match the Medicare enrollment. Otherwise TMHP conducts its own visit, asking about billing, accessibility and shared space, collecting a personnel list, licenses and the complaint policy, and photographing the building. Moderate and high risk providers cannot bill for a new practice location until it is approved.
For fingerprinting, wait for the six-digit service code TMHP mails after you submit, schedule with IdentoGO, and upload the receipt to PEMS within 30 days. The fee is $10 per person. Fingerprints taken for any other purpose do not count, although fingerprints already submitted to Medicare or another state Medicaid program can be documented by letter.
Revalidation
Most Texas Medicaid providers have a five-year enrollment period, and some have shorter periods based on risk level. Revalidation is filed online in PEMS and becomes available up to 180 days before the revalidation due date, and HHSC advises submitting at least 120 days before the enrollment period ends. An application submitted before the due date that reaches enrolled status within the 45-day grace period is treated as complete, with no gap in enrollment.
Providers who miss that window are disenrolled from Texas state health care programs and must file a reenrollment application, and the MCOs cannot keep paying a provider who is not enrolled. Revalidation repeats the full screening, including the application fee for institutional providers.
Texas Medicaid Managed Care Programs and Plans
HHSC contracts with health plans by program and by 13 service areas: Bexar, Dallas, El Paso, Harris, Hidalgo, Jefferson, Lubbock, Nueces, Tarrant, Travis, and the Medicaid Rural Service Areas for Central, Northeast and West Texas. The programs are:
- STAR: most children, pregnant women and families in Texas Medicaid
- STAR+PLUS: adults with disabilities and older adults
- STAR Kids: children and young adults with disabilities
- STAR Health: children in foster care, administered by Superior HealthPlan
- CHIP: the Children's Health Insurance Program
Current HHSC plan code listings show these STAR+PLUS plans by service area:
- Bexar: Community First Health Plans, Molina, UnitedHealthcare
- Dallas: Molina, Superior, UnitedHealthcare
- El Paso: El Paso Health, Molina
- Harris: Community Health Choice, Molina, UnitedHealthcare
- Hidalgo: Molina, Superior, UnitedHealthcare
- Jefferson: Molina, Wellpoint
- Lubbock, Nueces and Rural West Texas: Superior, Wellpoint
- Tarrant and Rural Northeast Texas: Molina, UnitedHealthcare
- Travis and Rural Central Texas: Superior, UnitedHealthcare
STAR Kids plans include Aetna, Blue Cross and Blue Shield of Texas, Community First, Cook Children's Health Plan, Driscoll Children's Health Plan, Superior, Texas Children's Health Plan, UnitedHealthcare and Wellpoint, each in specific service areas. STAR and CHIP line-ups differ again by area, so check the HHSC Health Plans by Service Area chart for your county before you apply.
Texas centralizes the credentialing step. Medicaid and CHIP plans use a single credentialing verification organization, managed by the Texas Association of Health Plans with Verisys as the vendor, which verifies your credentials once for all of them from the Texas Standardized Credentialing Application or your CAQH (now DataSpring) profile. A plan must finish credentialing, and load you as a network provider in its claims system, no later than 90 days after receiving a complete application, and recredentialing runs every three years with notice at least 180 days before the due date.
Typical Timeline, Start to Finish
- Document gathering and CAQH build or update: typically 1 to 2 weeks
- PEMS enrollment: typically up to 60 days once TMHP has everything it needs
- Moderate or high risk types: longer, because the site visit and fingerprinting are added
- MCO credentialing after enrollment: up to 90 days from a complete application, run in parallel across plans
A practice that files in PEMS on day one and sends every MCO request the day the enrollment is approved is typically billing its service area plans within four to six months. Have the CAQH profile attested before approval so the CVO is not waiting on you.
Where Texas Medicaid Applications Go Wrong
- Missing information not supplied within 30 business days, which ends the application
- Owner, creditor or principal entries that leave out someone with an ownership or control interest
- Fingerprints taken before the TMHP service code arrives, or the receipt not uploaded within 30 days
- A practice location on the application that does not match the Medicare record, which triggers a separate TMHP site visit
- Revalidation filed after the due date and the 45-day grace period
- MCO requests sent before the Medicaid enrollment is approved, or to a plan that does not serve the practice's service area
- An outdated CAQH profile, which stalls the CVO for every plan at once
How PECS Handles Texas Medicaid
PECS prepares and submits the PEMS application, tracks it with TMHP, coordinates any fingerprinting and site visit, then files the MCO applications for your service area the day the enrollment is approved, with regular follow-up to every payer and each contact logged to your reference number at pecs.health/status. Texas Medicaid enrollment is $500 per provider and each MCO application is $200 per application per provider, both billed 50% at engagement and 50% at submission. CAQH (now DataSpring) build is $500 and update is $250. Ongoing maintenance at $100 per provider per quarter includes revalidation tracking so the PEMS window never closes unnoticed.
Frequently Asked Questions
How long does Texas Medicaid provider enrollment take?
TMHP states that once it has all the necessary information, the enrollment process typically takes up to 60 days. Incomplete applications add time: TMHP gives you 30 business days to supply missing information, and high risk types must also complete fingerprinting. MCO credentialing comes after that, and Texas Medicaid plans must finish credentialing within 90 days of a complete application.
Do I need to enroll in Texas Medicaid if I only want to join the MCOs?
Yes. TMHP requires every provider to be enrolled in Texas Medicaid before enrollment can be approved for any other service or program, including Medicaid managed care. HHSC lists Medicaid managed care among the reasons a provider must enroll through PEMS. After that, you contract and credential separately with each health plan.
What is the Texas Medicaid application fee?
Individual physicians and non-physician practitioners do not pay an application fee. Institutional providers pay the federal application fee, which is $750 per application for calendar year 2026, at initial enrollment, new practice locations, revalidation and reenrollment. TMHP cannot process an application when a required fee is missing. Proof that the fee was already paid to Medicare or another state Medicaid program or CHIP can be submitted instead.
Who has to be fingerprinted for Texas Medicaid?
High risk providers and every owner with a 5 percent or greater direct or indirect ownership interest. TMHP mails a six-digit service code after you submit, you schedule with the state fingerprint vendor, IdentoGO, and you upload the receipt to the PEMS application within 30 days. The fee is $10 per person. Fingerprinting before you receive the service code causes deficiencies and delays.
How often do I have to revalidate with Texas Medicaid?
Most providers have a five-year enrollment period, and some have shorter periods based on risk. Revalidation is filed online in PEMS and opens up to 180 days before the due date, and HHSC advises submitting at least 120 days before the enrollment period ends. Providers who miss the due date and the 45-day grace period are disenrolled and must file a reenrollment application.
What is the Texas Medicaid credentialing verification organization?
Texas Medicaid and CHIP health plans use a single credentialing verification organization, managed by the Texas Association of Health Plans, with Verisys as the vendor. The CVO verifies your credentials once for all the Medicaid plans, using the Texas Standardized Credentialing Application or your CAQH (now DataSpring) profile, and recredentialing runs every three years. Each plan still issues its own contract.
Which managed care programs and plans serve Texas Medicaid?
HHSC runs STAR for children, pregnant women and families, STAR+PLUS for adults with disabilities and older adults, STAR Kids for children with disabilities, STAR Health for children in foster care, and CHIP. Plans are assigned by 13 service areas. STAR Health is administered by Superior HealthPlan, and the STAR+PLUS and STAR Kids plans include Superior, UnitedHealthcare Community Plan, Molina, Wellpoint, Community First, Texas Children's, Cook Children's and Driscoll.
What does PECS charge for Texas Medicaid enrollment?
Texas Medicaid enrollment through TMHP and PEMS is $500 per provider, billed 50% at engagement and 50% at submission. Each MCO application is $200 per application per provider on the same split, so a provider who wants the Medicaid enrollment and three plans in the service area pays $1,100 in total. CAQH (now DataSpring) build is $500 and update is $250. Ongoing maintenance including revalidation tracking is $100 per provider per quarter.
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By the PECS credentialing team, updated October 19, 2026.