How to become a Medicaid provider in Texas
To bill Texas Medicaid, enroll through Provider Enrollment and Management System (PEMS), run by TMHP, run by Texas Medicaid & Healthcare Partnership. The process has 6 steps, listed below with the documents the state asks for.
- Enrollment portal
- Provider Enrollment and Management System (PEMS), run by TMHP
- Steps
- 6
- Documents
- 6
- Plans listed
- 19
On this page
Texas Medicaid enrollment at a glance
To bill Texas Medicaid, enroll through Provider Enrollment and Management System (PEMS), run by TMHP, run by Texas Medicaid & Healthcare Partnership. The process has 6 steps, listed below with the documents the state asks for.
- Program
- Texas Medicaid and CHIP (Texas Health and Human Services Commission, HHSC)
- Enrollment portal
- Provider Enrollment and Management System (PEMS), run by TMHP
- Fiscal agent
- Texas Medicaid & Healthcare Partnership (TMHP), the claims administrator for HHSC
- Application fee
- Under the ACA, institutional providers owe an application fee on initial applications, new practice locations, revalidation and re-enrollment. PEMS says at the end of the application whether a fee is due, and the application cannot be processed without it. Proof of a fee paid to Medicare or another state must be submitted with the application. The amount changes each calendar year. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.
- Fingerprinting
- Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. The TMHP provider manual section we reviewed does not list a separate state fingerprint process.
- Site visit
- Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. TMHP's manual notes that moderate- and high-risk providers cannot bill for a new practice location until it is approved and added to the enrollment record.
- Revalidation
- Revalidation is due by the end of the enrollment period, called the 'revalidation due date'. Most providers have a five-year period, but some get shorter periods based on risk or other factors. Revalidation is filed online in PEMS only, opens up to 180 days before the due date, and repeats provider screening. It is not complete until every deficiency is resolved. If the period ends first, TMHP automatically disenrolls the provider. Group administrators can revalidate for their performing providers.
- Provider manual
- Provider manual
Steps
- Get an NPI and confirm the taxonomy codes for your provider type and specialty
- Fill out the enrollment application online in PEMS, including owner, creditor and principal entries
- E-sign the HHSC Medicaid Provider Agreement; for an entity, a principal with authority to bind it signs
- Pay the application fee if PEMS says one is due, or upload proof of prior payment
- Attach EFT information (voided check or bank letter) and the other documents PEMS asks for
- Once enrolled in Texas Medicaid, contract with MCOs/DMOs; all Medicaid MCOs credential through the TAHP-contracted CVO
Documents the state asks for
Joining managed-care plan networks
- Credentialing
- A provider must be enrolled in Texas Medicaid before any MCO or DMO can enroll it, and each plan sets its own contracting guidelines. Centralized credentialing: yes, for verification. All Medicaid MCOs must use the credentialing verification organization contracted by the Texas Association of Health Plans (TAHP), whether or not they belong to TAHP. Medicaid enrollment does not guarantee that a plan will contract with or credential a provider.
- Plans (state list)
- Aetna
- Blue Cross and Blue Shield of Texas
- Community First
- Community Health Choice
- Cook Children's
- Dell Children's
- Driscoll
- El Paso Health
- FirstCare
- Molina
- Parkland
- RightCare-Scott and White
- Superior
- Texas Children's
- United
- Wellpoint
- DentaQuest (dental, statewide)
- MCNA (dental, statewide)
- UnitedHealth Care Dental (dental, statewide)
Frequently asked questions
How do I become a Medicaid provider in Texas?
To bill Texas Medicaid, enroll through Provider Enrollment and Management System (PEMS), run by TMHP, run by Texas Medicaid & Healthcare Partnership. The process has 6 steps, listed below with the documents the state asks for.
Is there an application fee to enroll in Texas Medicaid?
Under the ACA, institutional providers owe an application fee on initial applications, new practice locations, revalidation and re-enrollment. PEMS says at the end of the application whether a fee is due, and the application cannot be processed without it. Proof of a fee paid to Medicare or another state must be submitted with the application. The amount changes each calendar year. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.
How often must Texas Medicaid providers revalidate?
Revalidation is due by the end of the enrollment period, called the 'revalidation due date'. Most providers have a five-year period, but some get shorter periods based on risk or other factors. Revalidation is filed online in PEMS only, opens up to 180 days before the due date, and repeats provider screening. It is not complete until every deficiency is resolved. If the period ends first, TMHP automatically disenrolls the provider. Group administrators can revalidate for their performing providers.