UnitedHealthcareHigh ImpactAdministrative
Texas Medicaid: CLIA certification must be current and active in PEMS
Published June 3, 2026Effective June 1, 2026
AI Summary
Texas Medicaid now requires all laboratory service providers to upload current CLIA certificates in the state's Provider Enrollment and Management System (PEMS). Claims will be denied starting June 1, 2026 if CLIA certificates are missing, outdated, or not properly reflected in PEMS.
Action Required
Before June 1, 2026: Laboratory billing team must verify CLIA certificate is active and updated in PEMS system. For waived-test-only laboratories, add QW modifier to all claims to prevent processing delays. Between March 1-May 31, 2026, monitor provider remittance advice (PRA) for CLIA certificate notices. Failure to maintain current CLIA certification in PEMS will result in claim denials after June 1, 2026.
Plan Types
Medicaid
States
TX
Specialties
laboratory