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UPDATE: Claim Denial Suspense for CLIA Certification Information in the HHSC PEMS

Date: 05/27/26

The previously communicated implementation date of June 1, 2026, for CLIA-related claim denials for missing or inaccurate CLIA certification information in the Texas Health and Human Services Commission (HHSC) Provider Enrollment Management System (PEMS) is no longer valid.

HHSC has directed Managed Care Organizations (MCOs) to continue to issue warning edits for missing or inaccurate CLIA certifications in PEMS as no new effective date to deny claims has been determined by HHSC at this time.

Providers should confirm that all applicable CLIA certification information has been properly entered and present in the HHSC PEMS and maintain updated CLIA certification information in PEMS as those certifications are renewed or changes made.

For any questions regarding these requirements, please contact your Provider Representative. To access their contact information visit Find My Provider Representative.

Please note: This is an update to the previously posted article: NOTICE: Medicaid and CHIP Providers Billing Laboratory Services Subject to CLIA Certification Requirements