Superior HealthPlan reminds all contracted providers that maintaining active Medicaid and/or CHIP enrollment with the Texas Health and Human Services Commission (HHSC) is mandatory in order to deliver and be reimbursed for covered services.
Enrollment Requirement
- Contracted providers must maintain active Medicaid and/or CHIP enrollment with HHSC to deliver services and receive payment.
- Services rendered while not actively enrolled will not be reimbursed, even if the provider is credentialed with Superior.
Revalidation Due Dates
- Every provider has a revalidation due date available in TMHP’s Provider Enrollment Management System (PEMS).
- Providers may begin revalidation up to 180 days (6 months) before the due date and are encouraged to start early.
Revalidation vs. Credentialing
- HHSC revalidation is separate from Superior’s credentialing/recredentialing.
- Providers must meet both requirements to serve Superior Medicaid and CHIP members.
Steps to Complete Revalidation
- Log in to PEMS and confirm your revalidation due date.
- Start or resume the revalidation application.
- Submit all required documentation.
- Respond promptly to any HHSC requests.
- Ensure the application reaches “closed‑enrolled” status by the due date.
Applications in Progress
- Starting revalidation is not enough—applications must be fully completed and approved by the due date to avoid disruptions.
- Early submission reduces risk from processing delays.
Risk of Missing the Due Date
- Provider disenrollment from Texas state health care programs.
- Loss of access to state-directed, quality, or enhanced payment programs.
- No payment for services rendered while disenrolled.
- Re-enrollment is required before services can resume.
Program Flexibilities
- Temporary enrollment extensions are ending and should not be relied upon.
- Early and proactive revalidation remains the best safeguard.
- Special Considerations by Provider Type
- Hospitals: Directed Payment Program participation and enhanced reimbursement may be affected.
- Nursing Facilities: QIPP and other quality-based payments may be impacted.
- Pharmacies: Claims may be denied at point of sale, disrupting member access to medications.
- Long-Term Care Providers: Care obligations may continue despite interrupted reimbursement.
- DME Providers: Claims will be denied if the ordering provider is not properly enrolled.
Contact your local Superior Provider Representative for assistance.
For full details and ongoing updates, visit the Superior Healthplan Newsroom.
