Skip to Main Content

IMPORTANT NOTICE: Medicaid and CHIP Program Provider Enrollment Revalidation

Date: 05/01/26

As a Superior HealthPlan contracted provider, you are required and responsible to maintain active Medicaid and/or CHIP enrollment through the Texas Health and Human Services Commission (HHSC) as a prerequisite for delivering covered Medicaid and CHIP services to Superior’s enrolled members. If Medicaid and CHIP services are provided to a Superior member by a provider that is not actively enrolled in the Medicaid and/or CHIP program through HHSC, no reimbursement of those services can be provided. We have included some important information below to ensure our providers are informed of HHSC requirements and protocols for the Texas state health care programs.

Know your Revalidation Due Date

Every enrolled provider has a revalidation due date. Log in to the Texas Medicaid Healthcare Partnership (TMHP) Provider Enrollment Management System (PEMS) today to confirm your date. You can start your revalidation up to 180 days (6 months) before the due date. Starting early allows enough time to complete the entire process on time and avoid Medicaid or CHIP program disenrollment.   

Please note: Revalidation for the Texas state health care programs is NOT Superior’s credentialing or recredentialing process/requirements necessary for providers to remain contracted in Superior’s network of providers. However, if providers are actively credentialed, but do not maintain Medicaid or CHIP Program provider enrollment through HHSC, providers are prohibited from providing services to Superior’s enrolled Medicaid and CHIP members. In addition, providers not actively enrolled in the state health care programs will not be reimbursed for any claims submitted if the provider is not actively enrolled on the date services are rendered.

If You Are Due for Revalidation in 6 Months and Have Not Started (180 Days)

You are eligible and encouraged to start now. Steps to Begin Revalidation:

  • Log into PEMS.
  • Identify the revalidation due date.
  • Start or resume revalidation application.
  • Submit all required documentation.
  • Respond promptly to requests for additional information.
  • Ensure application reaches “closed-enrolled” status before due date.

Key Messages for Providers with Revalidation in Progress and Due Within 180 Days

You have started the revalidation process and must continue to act to avoid disruptions. Starting is an important first step, but your application must be fully submitted and reach a “closed-enrolled” status in PEMS by the due date.

Immediate next steps to complete revalidation:

  • Log into PEMS and check your revalidation application status.
  • Confirm your revalidation due date.
  • Submit all outstanding required documentation.
  • Respond promptly to requests for additional information.
  • Ensure application reaches “closed-enrolled” status before due date.

Providers Pending State Review

HHSC is actively working to prevent provider disenrollment when applications are delayed after submission, including delays caused by high processing volumes. Providers are strongly encouraged to begin the revalidation process as early as possible. Early submission is the best way to reduce the risk of enrollment disruptions.

Why Timely Revalidation is Critical

If you fail to revalidate by your due date:

  • You will be disenrolled from Texas state health care programs.
  • You will lose access to state-directed payment programs.
  • You will not be paid for services provided to Medicaid members.
  • You must re-enroll to resume participation, and services provided while you are disenrolled will not be reimbursed.

Do Not Rely on Texas State Health Care Program Provider Enrollment Flexibilities

Temporary provider program enrollment extensions may allow limited additional time for a provider to submit application for program enrollment, but those temporary flexibilities are ending. They are intended to support providers through the revalidation process; however, providers are still expected to begin and submit revalidation as early as possible.

Providers should plan ahead and complete revalidation as early as possible to avoid disruptions.

Please note: HHSC is working to ensure that providers are not disenrolled if applications are delayed in the process after submission (e.g., high processing volumes). However, this cannot be guaranteed. Starting the revalidation process early is the best way to avoid disruptions.

Educate your provider practice, group, or facility regarding state health care program provider enrollment revalidation requirements

Make sure everyone in your organization understands the importance of revalidation, including:

  • Provider administrative staff, especially credentialing and billing staff
  • Contractors
  • Trainers
  • Any staff supporting provider enrollment or revalidation activities

Special Messages for Specific Provider Types regarding the Importance of Revalidation

Hospitals

  • If a facility fails to revalidate, the hospital’s participation in Directed Payment Programs (DPP) will be affected.
  • If a facility’s Texas state health care programs’ enrollment becomes inactive, the hospital’s eligibility for enhanced reimbursement tied to those programs could be impacted.

Nursing Facilities

  • If a nursing facility fails to revalidate, the facility’s participation or payments tied to Quality Incentive Payment Programs (QIPP) or other quality-based programs will be affected.

Pharmacies

  • If a pharmacy is not actively enrolled in the Texas state health care programs, prescription claims will be denied at the point of sale, disrupting members’ immediate access to medications.

Long-Term Care Providers (ICFs, NFs, HCS, SSLCs, ALFs, PPECCs)

  • Facilities and agencies may be expected to continue caring for residents even if your reimbursement is interrupted, which could create financial strain due to ongoing care obligations.

Durable Medical Equipment (DME) Providers

Even if you are a compliant DME provider, your claims will be denied if the ordering provider is not enrolled or revalidated.

For questions, please contact your local Superior Provider Representative. To find their contact information, please visit the Find My Provider Representative webpage.