In accordance with Tex. Gov’t Code Section 531.024162, as amended by Senate Bill 1207, HHSC is required to contract with an independent review organization (IRO) to perform external medical reviews (EMR) when requested by Medicaid members for certain benefits that have been denied, reduced, or terminated by their MCO or DMO.
The purpose of this training is to Provide an overview to providers on the role and responsibilities for participants involved in an external medical review following receipt of an appeal decision from El Paso Health.
Please update your enrollment and demographic information with TMHP (Texas Medicaid Healthcare Partnership). TMHP is HHSC’s provider enrollment administrator and serves as the authoritative source for HHSC Providers’ enrollment and demographic information. Once you update your enrollment and demographic information with TMHP, your data will be reconciled with the demographic information on file with the MCOs.
The TMHP Provider Enrollment webpage can be accessed at the following URL:
https://www.tmhp.com/topics/provider-enrollment
To make updates to your current enrollment (e.g., new practice locations or change of ownership updates), please access the
Provider Enrollment and Management System (PEMS) webpage at the following URL:
https://secure.tmhp.com/pems
“Step-by-Step Guide” can be accessed at the following URL:
https://www.tmhp.com/topics/provider-enrollment/pems/start-application
This page includes step-by-step instructions for maintenance requests as well as new enrollment, existing enrollment, revalidation, and reenrollment. Select the link under Existing Enrollment to access instructions for adding new practice locations or to submit a change of ownership. Select the link under Maintenance to access instructions for updating demographic data.
This page also provides links to the Enrollment Help page and the TMHP YouTube channel.
The TMHP YouTube channel has a playlist dedicated to PEMS. The playlist can be accessed here:
https://youtube.com/playlist?list=PLIe60BLvrbETbsHtKqwWrcvMmJ_6MH9n-&si=zHCYzyE5iqBYh7kR
Additional provider enrollment help can be found here:
https://www.tmhp.com/topics/provider-enrollment/provider-enrollment-help
