04/18/2025

Beginning May 30, 2025, the Provider Enrollment and Management System will be enhanced to streamline the process for Texas Medicaid enrollment and credentialing with Blue Cross and Blue Shield of Texas. This new feature will allow you to complete and submit your credentialing information as part of your enrollment or re-enrollment, or through a maintenance request — all within the Texas Medicaid & Healthcare Partnership’s PEMS tool.

Providers who wish to serve Texas Medicaid members through BCBSTX must first enroll and attest with Texas Medicaid prior to initiating credentialing with BCBSTX.

Providers enrolling in Medicaid: You will now initiate credentialing directly through PEMS. Follow these steps to get started:

• Access the credentialing application through the new credentialing tab in PEMS.
• Indicate “Yes” or “No” when prompted if you wish to begin credentialing with BCBSTX. The credentialing application within PEMS is not mandatory for Medicaid enrollment.  
• If you select “Yes,” you must complete the credentialing application fully before submitting both the Medicaid and credentialing applications.

Providers re-enrolling in Medicaid: You may complete your credentialing application during the re-enrollment process.

Currently enrolled Medicaid providers: You may access a new option in PEMS called Maintenance – Credentialing Information Request if you wish to initiate credentialing with BCBSTX.

Credentialing requirements: Credentialing involves verifying a provider’s qualifications, background, licensure, education, training, board certifications and professional history. You must submit your credentialing application electronically through PEMS and include all required documentation.

While PEMS will collect credentialing data, BCBSTX and our credentials verification organization will continue to manage the credentialing process. Our CVO will verify all submitted information to ensure it meets credentialing requirements. The CVO is responsible for receiving completed applications, provider attestations and conducting primary source verifications.

You must first be enrolled in PEMS to deliver Medicaid services through BCBSTX.

More details about credentialing in PEMS will be shared in upcoming communications at tmhp.com. Learn more about using PEMS.

Questions: If you have questions or require assistance, please reach out to our Medicaid Provider Network Team at 855-212-1615 or email Texas Medicaid Network Department.