Driscoll Health Plan credentialing for behavioral health providers and IOP/PHP programs

Part of our credentialing guide for Texas practices and programs. Other Texas plans: Superior HealthPlan · Molina · Texas Children's Health Plan · every Texas Medicaid plan.

Driscoll at a glance

Where Driscoll serves

Driscoll's 2023 behavioral health workshop gives its program history by area (Driscoll behavioral health workshop), and HHSC's managed care service areas map (2026 revisions) shows who else is there:

What that means for your program. Driscoll isn't a STAR+PLUS plan, so it doesn't cover adults with disabilities or adults 65 and older. Its members are mostly children and teens, children and young adults with disabilities (STAR Kids), and the pregnant women and parents in STAR.

• An adolescent IOP in Corpus Christi, McAllen, Brownsville or Laredo: Driscoll belongs on the first list, because it carries STAR and STAR Kids in both areas and CHIP in Nueces. See how to run an adolescent IOP in Texas.
• An adult SUD IOP: start with Superior (in STAR and STAR+PLUS in both areas), then add Driscoll for its adult STAR members, for whom it approves PHP and IOP as in-lieu-of services. Our city guides for Corpus Christi, the Rio Grande Valley and Laredo list the full local line-ups.

Contract status: HHSC's 2024 tentative STAR and CHIP awards left Driscoll out (Texas Tribune), and a Travis County judge then paused that procurement (Fierce Healthcare). We found no final new contracts, and Driscoll is on HHSC's 2026 map. Check the current map before you build a program around one plan.

Before you apply

• TMHP enrollment and an active NPI. Driscoll's Request for Contract says providers must be enrolled in Texas Medicaid and have an active NPI before they submit it. Driscoll also asks providers to keep enrollment and demographic data current with TMHP, because the plans reconcile their records against it. Our Texas Medicaid enrollment guide walks through PEMS.
• LPCs and LMFTs: Medicare, or the pediatric exemption. Since March 1, 2024, Texas Medicaid has required LPCs and LMFTs to enroll in Medicare or claim a pediatric practice exemption in PEMS (BCBSTX Medicaid notice, 2024). For a children's plan, the exemption is often the route; our Medicare guide for LPCs and LMFTs covers both.
• A current credentialing profile on CAQH ProView or Availity, with every document unexpired. The CVO works from it. Our CAQH ProView guide covers each section.
• For a program: the HHSC license for each site, covering the ages you treat, the organization NPI and TPI, liability certificates and an ownership chart. See how to get a Texas CDTF license.

PEMS credentialing. In April 2025 Driscoll told providers that PEMS would add a credentialing tab so providers could start managed care credentialing there, while the plans and the CVO keep their roles (Driscoll PEMS notice). HHSC postponed that update in May 2025, and a December 2025 Texas plan notice described a soft launch for facility credentialing only (Community Health Choice notice). Ask Driscoll which route it wants when you file.

The three forms

All three are on Driscoll's provider site (Request for Contract, new provider to existing group, expedited request). The Request for Contract we checked is dated April 2023, so download the current one before you fill it in.

Step by step

1. Confirm TMHP enrollment for each clinician and the facility, and that your PEMS, NPPES and CAQH addresses match.
2. Update CAQH or Availity. Driscoll's form asks you to make sure all information is updated and every required document is current before you send it.
3. Complete PROV-PR-033 for each location. Driscoll wants one form per practice or facility location. List your behavioral health specialty, the programs you want (STAR, STAR Kids, CHIP) and the ages you serve.
4. Email it to DHPContracting@Dchstx.org and keep the sent message as your start date.
5. Answer the CVO. Driscoll's form names Aperture, which older Texas plan documents name as the CVO, while its provider resources page names Verisys, the CVO the Texas Medicaid plans use now (TAHP's Credentialing 101). Either way, the shared CVO's verification counts for every Texas Medicaid plan, and the email asking for a missing item is the one to answer the same day.
6. Sign the contract and confirm the effective date and programs in writing before you schedule Driscoll members.

For questions, use the Provider Relations contacts on Driscoll's current provider page; numbers differ between its older documents. Driscoll doesn't publish a credentialing timeline; on our Texas roadmaps we budget about 90 days for a Medicaid plan after TMHP and CAQH are done.

Expedited credentialing

Texas law requires every Medicaid plan to offer expedited credentialing to a clinician who joins an established group that already contracts with the plan, is enrolled in Texas Medicaid, agrees to the group contract's terms and sends what the plan requires on time (Texas Government Code §540.0656; 1 TAC §353.423). Superior's guide to the same law lists LCSWs, LPCs, LMFTs and psychologists among the eligible behavioral health types.

Driscoll's addendum to PROV-PR-032 has the clinician attest to a Texas license in good standing with no disciplinary history and an active Texas Provider Identifier, and to hold members harmless. Its wording names the Texas Medical Board, so a counselor or social worker should ask Driscoll for its Expedited Credentialing Criteria and how to complete the attestation for their own board. The addendum also says provisional status doesn't make the clinician a participating provider until the Credentialing and Peer Review committee approves them (Driscoll expedited addendum). Building a group? Our Group Practice Launch carries every clinician's plans on one roadmap.

For IOP and PHP programs

A program contracts as a facility on the same Request for Contract, one form per site. Ask Driscoll which facility credentialing application it wants; many Texas Medicaid plans take the Texas Association of Health Plans' standardized Texas Facility/Ancillary/Long-term Care Credentialing Application, which must not be reworded or reformatted.

What Driscoll pays for, by program. Driscoll's quick reference tool (September 2026) lists, for CHIP:

For STAR and STAR Kids members 21 and older, Driscoll offers inpatient psychiatric care, partial hospitalization and intensive outpatient services as in-lieu-of services, with approval required (Driscoll's adult mental health and substance use page). Ask Driscoll how it authorizes PHP and IOP for members 20 and younger (see authorizations). Our Texas Medicaid IOP and PHP guide explains in-lieu-of services, and our guide to insurance contracts for treatment centers lists what to check before you sign: the codes, the per diem, which programs and ages, and whether your clinicians also need individual credentialing.

Authorizations by age and program

• Adults (21 and older) in STAR and STAR Kids: Driscoll's November 2024 notice says prior authorization will always be required for PHP and IOP, in network and out of network (Driscoll authorization update, November 2024). It reversed an earlier 2024 notice, so read the newest one.
• Members 20 and younger: a Driscoll medical necessity guideline said Driscoll wouldn't require authorization for PHP and IOP at these ages. Check the DHP authorization requirement lookup for each code before the first admission; the newest quick reference tools don't restate the age rule.
• Timing: Driscoll's quick reference tools require admission notification and the authorization request within one business day of admission unless noted otherwise, and Driscoll won't accept an authorization request after the claim is submitted.
• Where: the DHP provider portal.

Put the authorization number, dates and units in your EHR before day one, and request the concurrent review before the last approved day; our utilization review guide lays out the log. Cima EHR for IOP and PHP programs tracks authorized units against attendance so a lapsed authorization shows before the claim denies.

Claims: payer ID and 95 days

• Timely filing: claims within 95 days of the date of service, per Driscoll's 2026 quick reference tools (Driscoll STAR, CHIP and STAR Kids QRT, September 2026). Our timely filing guide has the Texas rules.
• Electronic claims: through Change Healthcare (Optum), payer ID 74284, on the same tools.
• Eligibility every month: Medicaid members can change plans; check on admission and on the first of each month. Our sister site's VOB checklist lists the questions.

Why Driscoll files stall

• The form sent before TMHP enrollment or with an inactive NPI; Driscoll requires both first.
• One form for several sites; Driscoll wants one per location.
• Expired documents in CAQH or Availity when the CVO pulls the file.
• An LPC or LMFT without Medicare or the pediatric exemption in PEMS.
• A facility license that doesn't cover the ages on the request.
• An adult PHP or IOP admission without authorization, or a request sent after the claim.
• Seeing members on expedited status before Driscoll confirms it in writing.

How we work a Driscoll file

Our credentialing service checks Driscoll's programs in your counties, enrolls you with TMHP, fills the right Driscoll form for each site, answers the CVO, follows up every two weeks, reviews the contract and confirms the effective date in writing before the first claim. On our Texas roadmaps, TMHP is budgeted at about 45 days and each Medicaid plan at about 90 days after TMHP and CAQH.

• Texas Medicaid enrollment with your first managed care plan (Driscoll or another): $500 per clinician.
• Driscoll as an additional plan for a clinician: $275 per plan.
• A program's facility contract with Driscoll: $950 per plan.

For example, a Corpus Christi adolescent IOP enrolling with TMHP and then contracting with Driscoll, Superior and UnitedHealthcare as a facility: $2,400. Total your own list with the credentialing cost calculator, or have TMHP and every plan carried on one dated roadmap in the IOP / PHP Program Launch.

Questions

More Texas plan guides: Superior HealthPlan · Molina · Wellpoint Texas · Texas Children's Health Plan · El Paso Health · Parkland Community Health Plan · Texas Medicaid plans by area

Sources

All checked October 24, 2026. Plans revise these pages and forms; open the current version before you rely on any detail.

1. Driscoll Health Plan, PROV-PR-033 Request for Contract (Texas Medicaid and NPI first, one form per location, CVO, CAQH or Availity). driscollhealthplan.com
2. Driscoll Health Plan, PROV-PR-034 Request to Credential New Provider to Existing Group. driscollhealthplan.com
3. Driscoll Health Plan, PROV-PR-032 Expedited Credentialing Request. driscollhealthplan.com
4. Driscoll Health Plan, PROV-PR-032 Expedited Credentialing Addendum. driscollhealthplan.com
5. Driscoll Health Plan, Mental Health and Substance Use Services for Adult Members. driscollhealthplan.com
6. Driscoll Health Plan, Authorization Requirement Updates for Behavioral Health Services, In Lieu of Services, November 15, 2024. driscollhealthplan.com
7. Driscoll Health Plan, STAR, CHIP and STAR Kids Quick Reference Tool, September 2026 (timely filing, payer ID, CHIP PHP and IOP codes, authorization timing). driscollhealthplan.com
8. Driscoll Health Plan, 2023 Behavioral Health Staff Workshop (service areas and program dates). driscollhealthplan.com
9. Driscoll Health Plan, PEMS update notice, April 17, 2025. driscollhealthplan.com
10. Community Health Choice, "PEMS Facility Credentialing Expanded Soft Launch," December 2025. communityhealthchoice.org
11. Texas HHSC, Managed Care Service Areas map (2026 revisions). hhs.texas.gov
12. Texas HHSC, Nueces STAR comparison chart (counties). hhs.texas.gov
13. Texas Association of Health Plans, "Credentialing 101," Fall 2024. tahp.org
14. Texas Association of Health Plans, Texas Facility/Ancillary/Long-term Care Credentialing Application, 2023. tahp.org
15. Texas Government Code §540.0656, Expedited Credentialing Process for Certain Providers. law.justia.com
16. 1 Tex. Admin. Code §353.423, Expedited Credentialing. law.cornell.edu
17. Blue Cross and Blue Shield of Texas Medicaid, "Reminder: Medicare Requires LPC and LMFT Enrollment," May 14, 2024. bcbstx.com
18. Texas Tribune, "State rejects health insurers' pleas to halt plan that will shake up coverage for 1.8 million Texans," June 6, 2024. texastribune.org
19. Superior HealthPlan, Expedited Credentialing guide. superiorhealthplan.com
20. Fierce Healthcare, "Texas pauses $116B Medicaid contract awards; state health plans relieved." fiercehealthcare.com

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