Notices for Providers
Texas Medicaid drug formulary
The Texas Vendor Drug Program (VDP) have made recent changes to Texas Medicaid drug formulary. This will be in effect January 26, 2023 on select medication(s) moving from “preferred” to “non-preferred” status and vice-versa.
To learn more about formulary changes impacted, please click here for more information.
Provider Enrollment and Management System (PEMS)
Network providers must maintain their enrollment and demographic information with Texas Medicaid Healthcare Partnership (TMHP). Provider Medicaid enrollment functions are available through Provider Enrollment and Management System (PEMS). Updates to provider’s current enrollment, new practice locations or change of ownership updates, can be made on this site titled ”Provider Enrollment and Management System (PEMS)”, accessible here.
For instructions on how to make other demographic updates to your current enrollment, access the site titled “Provider Enrollment Help”, accessible here.
Click here to view the Provider Alert.
Portal Use for Non-Contracted Providers
Texas Children’s Health Plan has a commitment to provide maximum security of member information, and a pledge to adhere to HIPAA privacy guidelines. Beginning September 1, 2018, we discontinued the access for non-contracted providers to the online provider portal. For non-contracted providers that currently have access, as your account is due for renewal, access will not be renewed. We apologize for any inconvenience this may cause. You may contact the Provider hotline at 832-828-1008 or Toll free: 1-800-731-8527.
To inquire about becoming a contracted provider please complete a Letter of Interest form and submit a W-9.
The Texas Children’s Health Plan Network Management Department will review to ensure the following criteria are met:
- Provider is a Texas Medicaid Provider, as applicable
- Provider delivers service in one of the Texas Children’s Health Plan service areas
- Provider has admitting privileges at a participating hospital within Texas Children’s Health Plan’s provider network, as applicable
- Service provided is an identified network need for Texas Children’s Health Plan
How to update member information if they have moved:
All address changes must be reported to HHSC. Members can contact HHSC by calling 2-1-1 or by updating their account on YourTexasBenefits.com.
It is important to make sure address information is updated in a timely manner to ensure families continue to receive information from Texas Children’s Health Plan and HHSC. If a member has moved to an area that is not covered by Texas Children’s Health Plan they will need to select a new health plan. If a family is unsure if they have moved to an area that is outside of Texas Children’s Health Plan’s service area, we can help them by connecting them to HHSC so the address change can be made. Members will continue to have access to care through Texas Children’s Health Plan until HHSC changes their address.
If a Member needs help, call Member Services toll-free at 1-866-959-2555 (STAR), 1-866-959-6555 (CHIP), or 1-800-659-5764 (STAR Kids).
Medicaid Fraud Notice
Texas Health Steps Regional Representative Contact List