2 Avoid denials and recoupments with these documentation basics Strong documentation protects your practice and supports accurate Medicaid billing. Recent reviews show that small documentation gaps often lead to denials and payment recoveries. A few simple habits can help reduce that risk. The most common issues we see: Missing Provider signatures or credentials. Every clinical entry must be signed and clearly show the Provider’s name and credentials. This supports the service billed and identifies who rendered the care. Late documentation or post-payment signatures. Notes should be completed at the time of service or shortly after. Adding signatures or making changes long after the visit, especially after a claim is paid, raises compliance concerns and may result in unsupported services. Missing start and end times for time-based services. Therapy and many behavioral health services require clear time documentation. Appointment schedules or check-in logs do not replace clinical notes and cannot support billed time. Outdated or missing plans of care. Physical therapy, occupational therapy, and speech therapy services must follow an active, signed plan of care. Expired or incomplete plans may result in denied claims. Inconsistencies between the medical record and the claim. Dates of service, rendering Provider information, and service details must match what is submitted for payment. Even small differences can trigger denials or recoupments. Taking a few extra minutes to review documentation before billing can help prevent recoupments and support Medicaid program integrity. Provider Relations or Compliance teams are available to help. PEMS+PLUS coming soon The current PEMS system will be replaced by PEMS+PLUS, allowing Providers to submit credentialing information during enrollment, reenrollment, or maintenance requests for Texas Medicaid, managed care organizations (MCOs), and dental maintenance organizations (DMOs). What this means for you Currently, Providers must submit credentialing information separately to MCOs or DMOs after enrolling with Texas Medicaid. The updated PEMS will simplify this process, allowing Providers to complete credentialing directly through the system, speeding up enrollment and increasing efficiency. Key updates to PEMS Credentialing tab. A new tab will allow Providers to easily submit credentialing information. Attestation requirement. Providers will only need to attest if they wish to credential with an MCO or DMO during enrollment or maintenance. Concurrent process. Providers initiating credentialing during enrollment must complete the application before submitting both Medicaid and credentialing applications. Maintenance requests. Providers can request credentialing postenrollment via a new maintenance request option. Credentialing process Providers will submit credentialing applications electronically, including required documentation (e.g., education, licensure, certifications). New Providers can credential during initial enrollment, and existing Providers can initiate or complete credentialing via the maintenance request option. Important note: Credential verification organizations will still verify all submitted information to ensure compliance with credentialing standards. For more details, visit the Texas Medicaid & Healthcare Partnership website, tmhp.com. resources
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