Texas Medicaid Adds Credentialing to PEMS for BCBSTX Providers

Texas Medicaid PEMS Update: New Credentialing Functionality 

Starting May 30, 2025, the Texas Medicaid Provider Enrollment and Management System (PEMS) will introduce a new credentialing feature for Blue Cross and Blue Shield of Texas (BCBSTX) providers. This update aims to streamline the enrollment and credentialing processes for Texas Medicaid providers by integrating both functions into a single platform managed by the Texas Medicaid & Healthcare Partnership (TMHP). 

What’s New 

The enhanced PEMS system will enable providers to submit credentialing information during: 

• New Medicaid enrollments 
• Re-enrollments 
• Maintenance requests 

This integration eliminates the need for separate systems, simplifying the process for providers. 

Key Details for Providers 

New Enrollments 

• A new Credentialing tab in PEMS will allow providers to access the credentialing application during Medicaid enrollment. 
• Providers will choose whether to initiate credentialing with BCBSTX: 
• Selecting “Yes” requires completing and submitting both the Medicaid and credentialing applications. 
• Selecting “No” allows providers to complete Medicaid enrollment without starting the credentialing process. 

Re-enrollments 

• Providers can submit credentialing applications as part of the re-enrollment process in PEMS. 

Currently Enrolled Providers 

• A new Maintenance – Credentialing Information Request option in PEMS enables providers to start the credentialing process with BCBSTX at any time. 

Credentialing Process 

The credentialing process involves verifying: 

• Licensure and education 
• Board certification and training 
• Work history and professional references 

Providers must submit all required documentation electronically through PEMS. While PEMS collects the data, BCBSTX and its Credential Verification Organization (CVO) handle the review, including: 

• Evaluating completed applications 
• Performing primary source verifications 
• Ensuring all credentialing requirements are met 

Important Note 

Providers must be enrolled and attested in Texas Medicaid before starting the credentialing process with BCBSTX to provide services to Texas Medicaid members. 

This update is designed to make the enrollment and credentialing processes more efficient for Texas Medicaid providers. 

Source: BCBSTX 

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