Provider Enrollment and Management System (PEMS) Frequently Asked Questions May 2025

Community First Health Plans is requiring Providers to ensure their information is aligned across the Provider Enrollment and Management System (PEMS) Master Provider File effective May 30, 2025.

As a Managed Care Organization (MCO), Community First Health Plans will contract, credential and pay only those providers who are properly enrolled with Texas Medicaid & Healthcare Partnership (TMHP) and whose information is received in the official PEMS file from TMHP.

Providers should log in to the PEMS Portal as soon as possible to verify/update the following:

Practice locations, addresses, programs, and providers
Corresponding group names for all locations
Taxonomy codes
If accepting new patients

IMPORTANT: Every Provider must be enrolled at each location where they see patients. This is to help ensure claims process correctly.

ABOUT PEMS: As a reminder, PEMS will be the only system used for enrolling, re-enrolling, revalidating, and maintaining provider records. Providers should update the information in PEMS as soon as possible. Updating data in PEMS will allow updates to flow to Community First and all MCOs through the Master Provider File, thus eliminating the need for Providers to update their information with all MCOs they are contracted with.

FAQs

Q: When is the PEMS Master Provider File effective date?
A: May 30, 2025

Q: How can a Provider verify their information in PEMS?
A: Providers should log in to the PEMS Portal as soon as possible to verify/update their information, including practice locations, group names, taxonomy codes, and if they are accepting new patients. Providers must also submit revalidation applications at least 120 days prior to the end of their enrollment.

Q: What are possible consequences of an address mismatch?
A: Community First’s Non-Emergency Medical Transportation (NEMT) vendor, SafeRide, relies on data in PEMS when scheduling transportation for Members. Address mismatches can cause delays. Additionally, address mismatches can impact online provider directories, licensing providers, and verifying credentials.

Q: What do I do if I get an error message when trying to update my practice address?
A: A practice location in PEMS must be a physical address, and it must not contain any repeating information or include any PO Boxes. If you receive this error message: “Practice Location already exists. Please enter a different address. This address already exists on another location and two locations cannot have the same address for the same location type.” email enrollmentoutreach@tmhp.com and include the following information:

NPI:
Duplicate Location You Want to Keep:
Duplicate Location You Want Removed:

Be specific on which locations you want to keep and which ones you want to remove. Include identifying information, such as effective dates, taxonomy codes, slight differences in the Practice Location address like a +4 on the zip code, or screenshots. After the enrollment record is corrected, TMHP will send you a Welcome Letter containing the updated practice location.

Q: If I update my information in PEMS, will Community First receive it?
A: Yes, once information is received and accepted in PEMS, it will flow from PEMS to Community First.

Additional PEMS Resources: