To become a Medicaid provider in Texas, you enroll through the Texas Medicaid & Healthcare Partnership (TMHP) using the Provider Enrollment and Management System (PEMS), after you have an active professional license, a National Provider Identifier, and any business registration your entity type requires. Every provider goes through PEMS, whether it’s a first-time application, a new practice location added to an existing record, a revalidation, or a reenrollment after termination.1Texas Medicaid & Healthcare Partnership. Provider Enrollment and Management System (PEMS) The Texas Health and Human Services Commission (HHSC) then screens your application at one of three risk levels, and that level determines whether you’ll also face fingerprinting and a site visit.
What You Need Before You Apply
Several pieces have to be in place before PEMS will get you anywhere. Missing any one of them will stall or kill the application.
Active License or Certification
Your state license or certification must be active and must match the name and credentials you enter in PEMS exactly. Enrollment is verified against the licensing board’s records, so a mismatch on the license number or the legal name will trigger a deficiency.
National Provider Identifier
Any healthcare provider who transmits health information in HIPAA-standard transactions, including billing, needs a National Provider Identifier (NPI). Type 1 NPIs are for individual providers such as physicians, nurse practitioners, and sole proprietors. Type 2 NPIs are for organizations like hospitals, nursing homes, and physician groups.2Centers for Medicare & Medicaid Services. National Provider Identifier Fact Sheet An individual provider who has also incorporated can hold both a Type 1 for the person and a Type 2 for the entity. Health plans, including Medicare and Medicaid, require NPIs in their administrative and financial transactions.3Centers for Medicare & Medicaid Services. National Provider Identifier Standard (NPI)
EIN and Business Registration
If you’re enrolling as an LLC, corporation, or partnership, you need an Employer Identification Number from the IRS. Get it directly through the IRS website, which is free; third-party sites charge for the same service.4Internal Revenue Service. Get an Employer Identification Number Business entities also have to register with the Texas Secretary of State before enrolling as a provider.5Office of the Texas Secretary of State. Office of the Texas Secretary of State
Enrolling Through PEMS
PEMS handles four request types. A new enrollment is for an NPI that has never been enrolled in Texas Medicaid. An existing enrollment request adds a new practice location or program to an active record. A revalidation renews an enrollment that’s still current. A reenrollment is for providers whose participation was previously terminated or disenrolled.1Texas Medicaid & Healthcare Partnership. Provider Enrollment and Management System (PEMS)
One trap catches providers who start an application and set it aside. If a PEMS application sits in draft status for 180 calendar days, the system expires it and you have to start over. TMHP sends an email warning 30 days before that happens, but if you miss the warning, the work is gone.
Application Fee
Institutional providers enrolling in Texas Medicaid or CHIP have to pay an application fee. For 2026 the fee is $750, up from $730 in 2025.6TMHP. Provider Enrollment Application Fee Set at $750 If you’ve already paid the enrollment application fee to Medicare or to another state’s Medicaid or CHIP program, you don’t have to pay it again; submit proof of that payment with your application instead.
Surety Bond Requirements
Some provider types have to maintain a surety bond as a condition of enrollment. That list covers durable medical equipment suppliers, opticians, orthotics and prosthetics providers, pharmacies in the Comprehensive Care Program, wheeled mobility services, non-government-operated ambulance providers, and hyperalimentation providers.7Texas Medicaid & Healthcare Partnership. Providers Are Required to Maintain Surety Bonds in PEMS If you’re on that list, the bond has to be in place and documented in PEMS before your enrollment can be finalized.
The Screening Level HHSC Assigns You
Every Medicaid provider application runs through a categorical risk screening at one of three levels: limited, moderate, or high. If a provider could fall into more than one level, the highest one applies.8eCFR. 42 CFR 455.450 – Screening Levels for Medicaid Providers You don’t pick your level, and you may not know it until you’re in the process.
At the limited level, HHSC verifies your credentials, confirms licensure in Texas and any other states, and runs database checks. At the moderate level, you get everything in a limited screening plus at least one unscheduled, unannounced site visit to your practice location, both before and after enrollment.9Cornell Law Institute. 1 Texas Administrative Code 352.9 – Screening Levels At the high level, you get everything in a moderate screening plus a criminal background check and mandatory fingerprint submission. Any owner with a 5% or greater direct or indirect ownership interest in a high-risk provider also has to submit fingerprints.10Texas Medicaid & Healthcare Partnership. ACA Screening Requirements
HHSC assigns your level based on federal guidance for your provider type, its own assessment of fraud and abuse risk for the category or geographic area, and factors like changes in business structure or your past practices.
What Happens During a Site Visit
If you’re screened at moderate or high risk, expect a TMHP representative to show up unannounced. During the visit, they’ll ask how you verify that billed services match services actually provided, whether your facility is accessible to people with disabilities, whether you share office space with other providers, who handles your billing, and whether any co-located businesses share ownership or specialty areas with you.10Texas Medicaid & Healthcare Partnership. ACA Screening Requirements
Adding or changing a practice location later doesn’t skip this step. Moderate and high-risk providers who add or change a location after their initial enrollment face a site visit before they can render services or submit claims from the new location.11Texas Medicaid & Healthcare Partnership. Provider Practice Location Requirements for Moderate and High Risk Providers
After You Submit
Processing time depends heavily on your risk level. A limited-risk application moves faster than a high-risk one that has to wait on fingerprints and site visits. If HHSC or TMHP finds problems, you’ll receive a deficiency letter asking for additional information or corrections. Respond quickly; the clock stops on their side and starts on yours.
Approval comes with written notification and a Texas Provider Identifier (TPI), which lets you begin rendering and billing for services. By signing the HHSC Medicaid Provider Agreement, you certify that everything in your application is complete and correct. Submitting false or misleading information can result in administrative, civil, or criminal liability.12Texas Medicaid & Healthcare Partnership. TMPPM Section 1: Provider Enrollment and Responsibilities
If Your Application Is Denied
Denial is not necessarily final. HHSC must give you written notice before denying, modifying, suspending, or terminating your provider status, and it must offer you a chance to request an administrative review. You generally have 30 calendar days from the date of the notice to submit a written request for review. If the review goes against you, you can request a fair hearing within 20 days of the review decision. Miss either deadline and the decision becomes final.13Texas Medicaid & Healthcare Partnership. Appeals and Administrative Review
Staying Enrolled: Revalidation and Records
Enrollment isn’t permanent. Federal law requires Medicaid providers to revalidate at least every five years, and providers in the high-risk screening category may need to revalidate every three to five years.9Cornell Law Institute. 1 Texas Administrative Code 352.9 – Screening Levels HHSC recommends submitting your revalidation application at least 120 days before your enrollment period ends.14Texas Health and Human Services. Medicaid and CHIP Enrollment and Revalidation TMHP suggests a wider cushion of 180 days to give reviewers time to work through the file.
Missing your revalidation deadline is expensive. Providers who don’t revalidate on time are disenrolled from all Texas state healthcare programs, including Medicaid managed care organizations and dental maintenance organizations. Once disenrolled, your claims and prior authorization requests are denied, and you have to file a full reenrollment application to get back in.1Texas Medicaid & Healthcare Partnership. Provider Enrollment and Management System (PEMS) Put the revalidation date on a calendar the day you receive your initial enrollment confirmation.
Ongoing documentation matters just as much. Every entry in a patient’s medical record has to be legible, dated, and signed by the performing provider. Records must include the patient’s name and Medicaid number on each page, document medical necessity for services rendered, and keep copies of any prior authorizations. Services that lack the mandatory documentation are subject to recoupment.12Texas Medicaid & Healthcare Partnership. TMPPM Section 1: Provider Enrollment and Responsibilities In practical terms, Texas Medicaid can take back money it already paid you if your charts don’t support the billed services.