Community Health Choice credentialing for behavioral health providers and IOP/PHP programs

Part of our credentialing guide for Texas practices and programs. Other Texas plans: Molina · Wellpoint Texas · Superior HealthPlan · every Texas Medicaid plan.

Community at a glance

Where Community serves

On HHSC's managed care service areas map (2026 revisions), Community appears in two service areas:

For a Houston-area adult program, Community is one of three STAR+PLUS plans, so it matters for adults with disabilities as well as for STAR and CHIP. In the Jefferson area it doesn't offer STAR+PLUS, so a Beaumont adult program leans on Molina and Wellpoint for those members (see our Molina guide and Wellpoint guide). Our Houston IOP guide covers the rest of the local picture. The Jefferson county list is from HHSC's service area by county appendix.

The application window

This is what sets Community apart from the statewide plans we've covered. Its 2025 annual notice to providers said Community would accept applications for its STAR, STAR+PLUS, CHIP, Medicare Advantage D-SNP and marketplace networks between January 2 and January 23, 2025, through the interest form on its provider site, and would answer every application within 90 days of receiving it.

• Ask Provider Relations now whether a window is planned for January 2027, and whether group additions to an existing contract are accepted outside it (the 2026 portal notice treats them as a separate request type).
• Have the file ready before the window opens: PEMS enrollment approved, NPPES matching, CAQH attested, license and liability certificates current. Three weeks isn't long enough to start TMHP from zero.
• Put the 90-day answer date on your calendar the day you submit, and follow up if it passes.

We didn't find a 2026 or 2027 notice; if Community has dropped the window, the steps below still apply. Contact Provider Relations at ProviderRelationsInquiries@CommunityHealthChoice.org or Provider Services at 713.295.2295 (1.888.760.2600), the routes Community lists.

Step by step

1. Enroll with TMHP. Community's join page tells Medicaid providers to enroll in PEMS and to update NPPES so it matches PEMS (Community's "Become a Community Provider" page). LPCs and LMFTs need Medicare enrollment first; Community reminded them in 2024 that this took effect March 1, 2024 (Community's Medicare reminder). Our Texas Medicaid enrollment guide walks through PEMS.
2. Finish CAQH ProView and authorize Community to view it (our CAQH guide). The CVO will use it.
3. Send the letter of interest through the portal. Since December 16, 2025, Community has taken onboarding, termination, demographic updates and group additions through its provider portal so providers can track them (December 2025 notice). From February 4, 2026, a Salesforce-based self-service portal takes network join requests and adds new providers to existing groups (January 2026 notice).
4. Answer Verisys. Once Community approves your interest, it sends your information to Verisys, which contacts you and performs primary-source verification. Community notes that, as a Medicaid plan, it must use the Texas Association of Health Plans' contracted CVO (see TAHP's Credentialing 101 for how the shared CVO works).
5. Sign and return the contract. The 90-day credentialing clock Community quotes starts when it has both your signed contract and the completed CVO file, so a contract sitting unsigned on your desk is time lost.
6. Confirm the effective date in writing and which products it covers (STAR, STAR+PLUS, CHIP, marketplace) before you schedule a Community member.

Joining a participating group

Community's join page says a provider joining a group that already participates can request expedited credentialing and serve Medicaid members provisionally while the application is pending. That's the Texas rule for every Medicaid plan (Texas Government Code §540.0656; 1 TAC §353.423): the clinician must be enrolled in Texas Medicaid and agree to the group contract's terms. Since February 2026 the request goes through the self-service portal as a group addition. It covers Medicaid members; for marketplace or D-SNP members, wait for full credentialing unless Community tells you otherwise in writing.

For IOP and PHP programs

A program joins as a facility through the same letter of interest, then the CVO's facility process. Ask Community which facility application it wants; the Texas Association of Health Plans publishes a standard Texas Facility/Ancillary/Long-term Care Credentialing Application used by Medicaid plans. Have the HHSC license for each site, the facility's Texas Provider Identifier, ownership disclosure, roster, liability certificates, W-9 and any accreditation letter ready; our credentialing documents checklist lists everything.

• Prior authorization: Community's 2021 prior authorization guide lists partial hospitalization and intensive outpatient programs among the behavioral health services that need authorization, and says the list changes; the current guide is on the provider portal. Pull it before your first admission.
• Which programs pay for it: adult PHP and IOP in Texas Medicaid are generally plan-offered "in lieu of" services billed by HCPCS code, not standard benefits. Ask Community in writing which programs (STAR, STAR+PLUS, CHIP, marketplace) your contract pays PHP and IOP for, at what rate and under which codes. Our Texas Medicaid IOP and PHP guide explains the rules.
• Criteria: Community's 2019 provider newsletter said it used InterQual criteria and couldn't share them with providers, though members could request the criteria used in a denial. Ask which criteria apply now, and document to them.

Before you sign, check the contract against our guide to insurance contracts for treatment centers; for a new program, the whole sequence is part of the IOP / PHP Program Launch.

Claims: payer ID, 95 days and UB-04s

The UB-04 point matters for programs. Facility IOP and PHP claims usually go on a UB-04 with revenue and HCPCS codes, and Community's January 2026 billing guidelines say UB-04s should be mailed rather than entered on its portal (Community claims billing guidelines, January 2026). Send them electronically through your clearinghouse under payer ID 48145 instead, and confirm with your clearinghouse that Community's institutional claims route is set up before the first claim. The STAR guide is Community's STAR quick reference guide; our sister site explains UB-04 versus CMS-1500 for behavioral health and timely filing limits.

Why Community files stall

• Missing the window, or applying in it with TMHP still pending.
• NPPES not matching PEMS, which Community's join page calls out.
• An LPC or LMFT without Medicare enrollment.
• An unsigned contract, which keeps the 90-day clock from starting.
• Slow answers to Verisys when it asks for a missing document.
• UB-04s keyed into the portal or sent to the wrong payer ID, and PHP or IOP started without an authorization.

How we work a Community file

On our Texas roadmaps, TMHP is budgeted at about 45 days and each Medicaid plan at about 90 days after TMHP and CAQH, so for Community we work backward from its window: PEMS and CAQH done before January, the letter of interest in on the first days, then follow-up every two weeks through Verisys and the contract. Our credentialing service does all of it and confirms the effective date in writing.

• Texas Medicaid enrollment with your first managed care plan (often Community, in Houston): $350 per clinician.
• Community as an additional plan for a clinician: $175 per plan.
• A program's facility contract with Community: $450 per plan.

For example, a Houston-area LPC who already has Medicare, applying to TMHP, Community and Molina, with CAQH built: $775. Run your own list through the credentialing cost calculator.

Questions

More Texas plan guides: Molina Healthcare of Texas · Superior HealthPlan · Wellpoint Texas · Baylor Scott & White Health Plan · Texas Medicaid plans by area · How long credentialing takes

Sources

All checked October 24, 2026. Community posts changes as dated notices; open its provider site for anything newer.

1. Community Health Choice, "Become a Community Provider" (letter of interest, PEMS and NPPES, Verisys, 90 days, expedited credentialing, TAHP CVO). communityhealthchoice.org
2. Community Health Choice, Annual Notice to Providers, January 2025 (application window, 90-day response). communityhealthchoice.org
3. Community Health Choice, "Community is Changing its Provider Onboarding and Termination Process," effective December 16, 2025. communityhealthchoice.org
4. Community Health Choice, "Community is Changing its Provider Onboarding Process," effective February 4, 2026. communityhealthchoice.org
5. Community Health Choice, "Reminder: LPC and LMFT Providers Must Enroll in Medicare Effective 03/01/2024." communityhealthchoice.org
6. Community Health Choice, Prior Authorization Guide, 2021. communityhealthchoice.org
7. Community Health Choice, 2019 provider newsletter, volume 3 (InterQual criteria). communityhealthchoice.org
8. Community Health Choice, STAR Quick Reference Guide, October 2024 (payer ID, 95 days, claims address). communityhealthchoice.org
9. Community Health Choice, Provider Claims Billing Guidelines, January 2026. communityhealthchoice.org
10. Texas HHSC, Managed Care Service Areas map (2026 revisions). hhs.texas.gov
11. Texas HHSC, STAR+PLUS service area by county (appendix). fhb.hhs.texas.gov
12. Texas Association of Health Plans, "Credentialing 101," Fall 2024. tahp.org
13. Texas Association of Health Plans, Texas Facility/Ancillary/Long-term Care Credentialing Application, 2023. tahp.org
14. Texas Government Code §540.0656, Expedited Credentialing Process for Certain Providers. law.justia.com
15. 1 Tex. Admin. Code §353.423, Expedited Credentialing. law.cornell.edu

This guide is general information. Cima Consulting isn't a law firm or an accounting firm. Community Health Choice, HHSC and TMHP make their own decisions; we don't guarantee approvals, rates or dates. We aren't affiliated with Community Health Choice or the Harris Health System.