MedicaidAdministrativeHigh impact
New TMHP CLIA Laboratory Certification Web Page Now Available
Texas Medicaid·TX·General
We identified it
Aug 18, 2026
Summary
TMHP has launched a new CLIA Laboratory Certification web page with an updated HCPCS Certification Data spreadsheet that maps procedure codes to required CLIA laboratory certifications. Providers performing laboratory services must ensure their CLIA certification information is current in PEMS to receive Medicaid reimbursement, and must verify that codes are Texas Medicaid benefits before billing.
Action Required
IMMEDIATE: Billing team must (1) Access the new TMHP CLIA Laboratory Certification web page at tmhp.com and download the HCPCS Certification Data spreadsheet; (2) Cross-reference all laboratory procedure codes currently billed by the practice against the required CLIA certifications listed in the spreadsheet; (3) Verify each code is a Texas Medicaid benefit using the Online Fee Lookup tool. PROVIDERS/ENROLLMENT STAFF: (1) Review current CLIA certification status in PEMS immediately; (2) Determine enrollment status (disenrolled, enrolled outside revalidation window, enrolled within revalidation window, or revalidation already submitted); (3) Submit appropriate PEMS transaction (Reenrollment, Maintenance, Existing Enrollment, or Revalidation) with updated CLIA information on the License/Certification/Accreditation tab based on enrollment status; (4) Ensure CLIA certifications match those required for all laboratory codes being billed. DEADLINE: Complete PEMS CLIA updates before the next revalidation cycle to avoid claim denials. CONSEQUENCE: Claims for laboratory services will be denied if provider's CLIA certification does not match CMS/TMHP requirements for the billed procedure code, or if CLIA information in PEMS is outdated. Contact TMHP at 800-925-9126 or TMHP-CSHCN at 800-568-2413 for assistance.