Every clinician who treats Texas Medicaid members, whether through traditional Medicaid or a STAR managed care plan, must first be enrolled with Texas Medicaid through TMHP. Enrollment comes before any plan will approve you, and missing a revalidation removes you from every plan network at once. Here is how Texas Medicaid provider enrollment works, step by step, based on the September 2026 Texas Medicaid Provider Procedures Manual.
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Who Runs Medicaid Enrollment in Texas
Texas Medicaid is administered by the Texas Health and Human Services Commission (HHSC). Provider enrollment is handled by the Texas Medicaid & Healthcare Partnership (TMHP), the program’s claims administrator, through PEMS, the Provider Enrollment and Management System. The rules are set out in Section 1 of the Texas Medicaid Provider Procedures Manual (TMPPM).
Before You Start
- An NPI. Texas requires it before you apply.
- Your primary taxonomy code.
- A current Texas license that will not expire within 30 days.
- Banking information for electronic funds transfer, through a voided check or bank letter.
- For a corporation, the Franchise Tax Account Status page and the Certificate of Formation, with a name that matches the W-9 exactly.
- Medicare enrollment, for provider types that require it.
How to Enroll, Step by Step
- Apply in PEMS as an individual, as a performing provider under a group, or as a group or facility, and choose your primary taxonomy.
- Complete the ownership information, including entries for owners with 5% or more interest, officers, and managing employees, and the Disclosure of Ownership and Control Interest Statement.
- Sign the HHSC Medicaid Provider Agreement electronically.
- Pay the application fee, if one applies to your provider type.
- Complete screening for your risk level.
- Fix deficiencies within 30 business days. If you don’t, the application is terminated, and an application cannot stay open more than 165 cumulative business days.
- Watch for your approval email, followed by an enrollment letter the next day.
Fingerprinting
High-risk providers and their owners with 5% or more interest must be fingerprinted, and proof must be uploaded within 30 days. TMHP’s fingerprinting FAQ directs applicants to IdentoGO, at $10 per person, and to wait for the service code before booking an appointment.
Is There an Application Fee?
Only institutional providers pay the application fee, which TMHP set at $750 for 2026. It applies to initial enrollment, re-enrollment, revalidation, and new locations, and it is waived with proof it was already paid to Medicare or another state. Individual practitioners do not pay it.
Managed Care: Texas Medicaid First, Then Each Plan
TMPPM states that all providers must be enrolled in Texas Medicaid before enrollment can be approved for Medicaid managed care. After that, you enroll with each health plan separately. Texas managed care programs include STAR, STAR+PLUS, STAR Kids, STAR Health, and CHIP. HHSC lists managed care organizations including Aetna, Blue Cross and Blue Shield, Community First, Community Health Choice, Cook Children’s, Dell Children’s, Driscoll, El Paso Health, Molina, Parkland, Superior, Texas Children’s, UnitedHealthcare, and Wellpoint, and dental maintenance organizations DentaQuest, MCNA Dental, and UnitedHealthcare Dental. Which plans operate in your area depends on your service area.
Ordering and Referring Providers
Clinicians whose only role is ordering or referring must still enroll, including when the patient is in a managed care network, CHIP, Healthy Texas Women, or the Children with Special Health Care Needs program. Interns and residents who hold only training permits cannot enroll.
Behavioral Health Clinicians
According to the current TMPPM Behavioral Health Handbook, LCSWs, LPCs, LMFTs, and psychologists must be enrolled in Medicare or qualify for a pediatric practice exemption. Temporary licenses are not accepted for LCSWs, LPCs, or LMFTs. Older editions of the manual described LPCs and LMFTs differently, so check the current handbook for your license. Our Texas behavioral health billing page covers the billing side.
Dentists
Children’s dental services in Texas Medicaid are delivered through the dental maintenance organizations, so dentists enroll with Texas Medicaid and then contract with the DMOs. Our Texas dental billing services page covers the billing side for dental practices.
Revalidation
Most providers have a five-year enrollment period, and some are shorter depending on risk. You can revalidate up to 180 days early, and there is a 45-day grace period. A provider who misses revalidation is disenrolled from all programs, including managed care and dental plan networks.
How Long It Takes
TMPPM states that enrollment typically takes up to 60 days once the application is complete. Plan credentialing follows, so allow several months before you see STAR plan members.
Common Reasons Applications Stall
- A corporate name that does not match the W-9 exactly.
- A license that expires within 30 days of the application.
- Missing the 30-business-day window to fix deficiencies.
- Incomplete ownership and managing-employee information.
Let Us Handle Texas Medicaid Enrollment
Maximum Billing handles Texas Medicaid enrollment through PEMS, managed care credentialing, CAQH, and revalidation tracking for Texas practices. See our behavioral health credentialing services, medical credentialing services, dental credentialing services, and Texas medical billing services, or contact us to get started.
This guide reflects official HHSC and TMHP information, including the September 2026 TMPPM, as of October 2026. Requirements change, so confirm current rules with TMHP before you apply.