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
Apr 1, 2026
Summary
Texas Medicaid now requires all laboratory service providers to maintain current and active 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 Claims will be denied starting June 1, 2026 if CLIA certificates are missing, outdated, or not reflected in PEMS.
Action Required
By May 31, 2026: Laboratory billing team 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. Update billing software to include CLIA verification step. Claims will be denied starting June 1, 2026 if CLIA certificate is missing, outdated, or not reflected in PEMS.