El Paso Health credentialing for behavioral health providers and IOP/PHP programs

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

El Paso Health at a glance

Where it serves, and why STAR+PLUS matters

The El Paso service area is two counties, El Paso and Hudspeth. On HHSC's managed care service areas map (2026 revisions), the line-up is short:

El Paso Health announced its STAR+PLUS contract for El Paso and Hudspeth counties, effective September 1, 2024 (El Paso Health STAR+PLUS notice). HHSC's STAR+PLUS plan code table shows El Paso Health starting on that date, Molina continuing, and Wellpoint's El Paso STAR+PLUS contract ending August 31, 2024 (HHSC STAR+PLUS plan codes). El Paso Health's STAR+PLUS page lists behavioral health among the acute care services it covers.

For an adult program, that makes El Paso a two-application market: El Paso Health and Molina are each in STAR and STAR+PLUS, so two contracts cover both adult Medicaid programs in the county. An adolescent program adds Superior for STAR and CHIP and Superior or Wellpoint for STAR Kids. Our El Paso IOP guide covers licensing, the building and referral sources, and our Molina guide covers the other STAR+PLUS plan.

Before you apply

• TMHP enrollment in PEMS, with your Texas Provider Identifier. Texas Medicaid plans credential providers who are already enrolled, and El Paso Health's expedited rules name Medicaid enrollment as a condition. Our Texas Medicaid enrollment guide walks through PEMS.
• LPCs and LMFTs: Medicare first. El Paso Health reminded LPCs and LMFTs that, effective March 1, 2024, they must enroll in Medicare to enroll in Texas Medicaid, unless they qualify for the pediatric practice exemption (El Paso Health Medicare reminder). That matters more here than in most places: for STAR+PLUS adults who also have Medicare, Medicare is billed first. See our Medicare guide for LPCs and LMFTs.
• CAQH or Availity complete and current. El Paso Health's 2019 behavioral health training described submitting the credentialing application through Availity after a demographic form with El Paso Health (El Paso Health behavioral health training, 2019); ask whether that's still the order. Our CAQH ProView guide covers the profile.
• For a program: the HHSC license for each site, the organization NPI and TPI, liability certificates and an ownership chart. See how to get a Texas CDTF license.

PEMS credentialing. El Paso Health told providers in 2025 that PEMS would add a way to start managed care credentialing inside TMHP's system (El Paso Health PEMS notice). HHSC postponed it in May 2025, and a December 2025 Texas plan notice described a soft launch for facility credentialing only (Community Health Choice notice). Ask El Paso Health which route it wants when you file.

Step by step

1. Send the request. El Paso Health's Provider Contracting and Credentialing page has a form for adding a provider to its network and says it replies by email. Its 2025 quick reference guide lists Contracting_Dept@elpasohealth.com for joining the network and for credentialing and contracting status (El Paso Health quick reference guide, 2025).
2. Name what you want: STAR, STAR+PLUS, CHIP or all three; individual, group or facility; each service address; and your behavioral health specialty (mental health, substance use or both). Ask whether the network is open for that specialty.
3. Complete the demographic form El Paso Health sends and the credentialing application (CAQH or Availity).
4. Answer Verisys quickly; El Paso Health ties the 90-day estimate to how responsive you are.
5. Sign the contract and confirm the effective date and the programs it covers in writing before you schedule El Paso Health members.

Verisys, 90 days and recredentialing

El Paso Health's September 2025 provider training says it uses Verisys as its credentialing, recredentialing and provider data management company, and that credentialing may take up to 90 days depending on the provider's responsiveness and the accuracy of the documents (El Paso Health provider training, September 2025). Its EPH 101 training says no provider participates before credentialing, that it follows NCQA-compliant procedures checking licensure, education, training, malpractice history and sanctions, and that it recredentials every three years (EPH 101 topics).

Verisys is the single credentialing verification organization the Texas Medicaid plans share, managed by the Texas Association of Health Plans since 2018 (TAHP's Credentialing 101), and El Paso Health's contracting page links its FAQs on that consolidated CVO. If you're also applying to Molina or Superior, the verification is done once and counts for all three; each plan still decides and contracts on its own.

Expedited credentialing

El Paso Health's contracting page sets out the four conditions Texas law uses (Texas Government Code §540.0656; 1 TAC §353.423): the clinician is a member of an established group with a current El Paso Health contract, is enrolled as a Medicaid provider, agrees to the group contract's terms, and sends all the documentation El Paso Health requires promptly. A clinician who qualifies completes El Paso Health's Provider Demographic Form and emails it to Contracting_Dept@elpasohealth.com. Don't schedule members under the new clinician until El Paso Health confirms the provisional status in writing. 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. Ask El Paso Health which facility 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.

Our Texas Medicaid IOP and PHP guide explains in-lieu-of services and the HCPCS billing, and our Medicare IOP and PHP guide covers the Medicare side of dual-eligible adults. Our guide to insurance contracts for treatment centers lists the rest of what to check before you sign.

After you're in: auths, claims, changes

• Prior authorization: El Paso Health's 2025 quick reference guide lists a Behavioral Health Prior Authorization Form, sent by fax, and its portal takes prior authorization submissions and amendments. Pull the current authorization list and the form before your first admission, and check PHP (H0035) and IOP (H0015, S9480) codes.
• Claims: El Paso Health's EDI instructions list payer IDs EPF02 for STAR and EPF03 for CHIP (El Paso Health EDI instruction sheet); ask which ID STAR+PLUS uses. Take the filing limit from your contract; Texas Medicaid plans commonly use 95 days from the date of service, and our timely filing guide has the Texas rules.
• Changes: El Paso Health's 2024 behavioral health orientation tells providers to notify Contracting and Credentialing or Provider Relations of changes such as a new practice location or group membership (El Paso Health behavioral health orientation, May 2024). A clinician who joins or leaves without a roster update causes denials.
• Eligibility every month: Medicaid members can change plans; check on admission and on the first of each month. Our sister site's prior authorization guide covers the request itself.

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.

Why El Paso Health files stall

• No TMHP enrollment yet, or an LPC or LMFT without Medicare or the pediatric exemption.
• Slow or inaccurate answers to Verisys, which El Paso Health names as the variable in its 90 days.
• Asking for STAR only when the adults you treat are in STAR+PLUS.
• Asking for STAR Kids, which El Paso Health doesn't offer.
• Name, address or Tax ID mismatches between the W-9, NPPES, PEMS and CAQH.
• A new location or clinician not reported to Contracting and Credentialing.

How we work an El Paso Health file

Our credentialing service enrolls you with TMHP, files the El Paso Health request for the programs you need, answers Verisys, 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, which matches El Paso Health's own estimate.

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

For example, an El Paso adult SUD program enrolling with TMHP and contracting with El Paso Health and Molina as a facility: $1,450. 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: Molina · Superior HealthPlan · Wellpoint Texas · Driscoll Health Plan · Texas Children's Health Plan · 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. El Paso Health, Provider Contracting and Credentialing (request form, expedited credentialing conditions, Provider Demographic Form, CVO FAQs). elpasohealth.com
2. El Paso Health, STAR/CHIP/STAR+PLUS Quick Reference Guide, 2025 (contracting email, behavioral health prior authorization form). elpasohealth.com
3. El Paso Health, provider training, September 17, 2025 (Verisys, up to 90 days). elpasohealth.com
4. El Paso Health, EPH 101 Topics (NCQA procedures, three-year recredentialing). elpasohealth.com
5. El Paso Health, Behavioral Health Specialty Training, April 2019 (demographic form, Availity application). elpasohealth.com
6. El Paso Health, Behavioral Health Provider Orientation, May 2024 (portal functions, changes to report). elpasohealth.com
7. El Paso Health, STAR+PLUS provider notice (effective September 1, 2024; El Paso and Hudspeth). elpasohealth.com
8. El Paso Health, Texas STAR+PLUS Benefits. elpasohealth.com
9. El Paso Health, "Reminder: LPC and LMFT Providers Must Enroll in Medicare Effective March 1, 2024." elpasohealth.com
10. El Paso Health, "Coming Soon: PEMS to Be Updated to Allow Provider Credentialing." elpasohealth.com
11. El Paso Health, EDI Provider Instruction Sheet (payer IDs). elpasohealth.com
12. Community Health Choice, "PEMS Facility Credentialing Expanded Soft Launch," December 2025. communityhealthchoice.org
13. Texas HHSC, Managed Care Service Areas map (2026 revisions). hhs.texas.gov
14. Texas HHSC, STAR+PLUS Program Support Unit Operational Procedures Handbook, Appendix XXIX, STAR+PLUS plan codes and contract numbers. fhb.hhs.texas.gov
15. Texas Association of Health Plans, "Credentialing 101," Fall 2024. tahp.org
16. Texas Association of Health Plans, Texas Facility/Ancillary/Long-term Care Credentialing Application, 2023. tahp.org
17. Texas Government Code §540.0656, Expedited Credentialing Process for Certain Providers. law.justia.com
18. 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. El Paso Health, HHSC and TMHP make their own decisions; we don't guarantee approvals, rates or dates. We aren't affiliated with El Paso Health.