Beginning May 30, 2025, the Provider Enrollment and Management System (PEMS) will be enhanced to streamline the process for Texas Medicaid enrollment and credentialing with Community First Health Plans, Inc. (Community First). This new feature will allow Providers to complete and submit their credentialing information as part of their enrollment, reenrollment, or through a maintenance request—all within PEMS.
Community First islicensed by the Texas Department of Insurance (TDI) and is under contract with the Texas Health and Human Services Commission (HHSC) to deliver Medicaid services in the region. Providers who wish to serve Texas Medicaid members through Community First must first enroll with Texas Medicaid prior to initiating credentialing with Community First.
PEMS Enhancements
A new Credentialing Tab will be added to PEMS, giving Providers access to the credentialing application. While Community Firstand its Credentials Verification Organization (CVO) will continue to manage the credentialing process, Providers will now initiate credentialing directly through PEMS.
Although the credentialing application will be available within PEMS, it is not mandatory for Medicaid enrollment. Providers will be asked to indicate “Yes” or “No” when prompted if they wish to begin credentialing with Community First. If “Yes” is selected, the provider must complete the credentialing application fully before submitting both the Medicaid and credentialing applications.
Providers undergoing reenrollment may also complete their credentialing during that process.
Note: While PEMS will collect credentialing data, Community First’s 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.
A new option, Maintenance – Credentialing Information Request, will also be available for Providers currently enrolled with Texas Medicaid who wish to initiate credentialing with Community First through PEMS.
Credentialing Requirements
Credentialing involves verifying a provider’s qualifications, background, licensure, education, training, board certifications, and professional history. Providers must submit their credentialing application electronically through PEMS and include all required documentation.
All Providers must first be enrolled in PEMS to deliver Medicaid services through Community First. New Providers can complete credentialing during the enrollment process, while current Providers can initiate it via a Maintenance Request.
More details about credentialing in PEMS will be shared in upcoming communications available at tmhp.com.
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6294. You can also contact your Provider Relations Representative directly.
To access all Provider alerts:
- Log into the Community First Provider Portal
- Go to CommunityFirstHealthPlans.com/Provider-News
- Sign up for the Community First Provider eNewsletter
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