MedicaidAdministrativeHigh impact
Texas Medicaid: CLIA certification must be current and active in PEMS
UnitedHealthcare·TX·State news
Effective date
Jun 1, 2026
We identified it
Jun 13, 2026
Summary
Texas Medicaid now requires all laboratory service providers to upload and maintain current CLIA certificates in the state's Provider Enrollment and Management System (PEMS). Starting June 1, 2026, claims will be denied if CLIA certificates are missing, outdated, or not reflected in PEMS.
Action Required
By May 31, 2026: Laboratory billing staff must verify CLIA certificate is active and updated in PEMS before submitting any laboratory claims. Add QW modifier to claims if laboratory is certified only for waived tests. Starting June 1, 2026, claims will be denied without proper CLIA certification in PEMS.