Texas Medicaid and BCBSTX Integrate Credentialing into PEMS — Effective May 30, 2025

05/05/2025

Texas Medicaid and BCBSTX Streamline Credentialing with New PEMS Integration — Effective May 30, 2025

Starting May 30, 2025, healthcare providers enrolling in Texas Medicaid or seeking credentialing with Blue Cross and Blue Shield of Texas (BCBSTX) will benefit from significant enhancements to the Provider Enrollment and Management System (PEMS). These updates are designed to simplify and consolidate the credentialing process within a single digital platform, improving efficiency and reducing administrative burden for providers across the state.

What’s Changing?

Under the updated system, credentialing for BCBSTX can now be initiated and completed directly through PEMS, which is managed by the Texas Medicaid & Healthcare Partnership (TMHP). The credentialing process has been fully integrated into the existing workflows for:

Initial enrollment
Re-enrollment
Maintenance requests

By centralizing credentialing within PEMS, the state aims to create a more streamlined and transparent process, allowing providers to manage Medicaid and BCBSTX participation from a unified interface.

Important Requirement: Medicaid Enrollment Comes First

Before beginning the credentialing process with BCBSTX, providers must first enroll and attest with Texas Medicaid via PEMS. Only after this step is completed can providers initiate credentialing with BCBSTX through the system.

Instructions by Provider Status

New Medicaid Enrollees:
After accessing the new Credentialing tab in PEMS, users will be prompted to indicate whether they wish to apply for BCBSTX credentialing. If so, they must complete the full credentialing application and submit it alongside their Medicaid enrollment documents.
Re-enrolling Providers:
Credentialing with BCBSTX can be completed as part of the re-enrollment process in PEMS, offering an efficient way to manage both requirements simultaneously.
Currently Enrolled Providers:
Those already enrolled in Medicaid can use the Maintenance – Credentialing Information Request feature within PEMS to initiate credentialing with BCBSTX.

What Credentialing Involves

Credentialing is a formal process that verifies a provider’s qualifications, including:

Licensure and education
Board certifications
Work history and professional background

All credentialing applications must be submitted electronically through PEMS, complete with required documentation. While TMHP’s system collects the data, BCBSTX and its Credentialing Verification Organization (CVO) will conduct the credentialing review, including primary source verification and application validation.