Humana behavioral health credentialing in Texas: what you're really joining in 2026

Part of our credentialing guide for Texas practices and programs. Other plans: UnitedHealthcare / Optum · Aetna · VA Community Care · Magellan and Carelon.

Humana at a glance

• What Humana sells in Texas: Medicare Advantage plans (HMO and PPO). Not employer group medical plans (exited in 2025), not Texas Medicaid, not TRICARE in Texas.
• Where to start: Humana's Join our network page and its Behavioral Health Provider Inquiry Form. Humana Provider Relations: 800-626-2741, 8 a.m. to 5 p.m. Central, Monday through Friday.
• CAQH: required. Humana's CAQH page says it uses CAQH ProView, and you must authorize Humana to see your profile.
• Medicare first: Medicare Advantage members are Medicare beneficiaries, so enroll in Medicare (PECOS) before or alongside your Humana request.
• Answer time in Texas: written notice of acceptance or non-acceptance within 90 days of the application, per Humana's Texas credentialing page.
• Portal: Availity Essentials, for eligibility, authorizations and claims.
• Recredentialing: on a 36-month cycle under Humana's credentialing policy.

Which Humana members exist in Texas now

Many Texas providers still think of Humana as a commercial plan. That changed:

Looking for Ambetter? That's the marketplace plan Superior HealthPlan sells in Texas, not Humana; see our Superior HealthPlan guide.

Why Humana wants counselors and therapists

Two federal changes made Medicare Advantage plans recruit behavioral health clinicians who couldn't bill Medicare before:

• Medicare pays LPCs and LMFTs. The Consolidated Appropriations Act, 2023 created Medicare Part B payment for marriage and family therapists and mental health counselors (in Texas, LMFTs and LPCs) starting January 1, 2024. Our guide to Medicare for LPCs and LMFTs walks through enrollment.
• Plans have to show enough of them. CMS's rule for 2025 added an "Outpatient Behavioral Health" category to Medicare Advantage network adequacy standards, which can count MFTs, mental health counselors, community mental health centers, opioid treatment programs and others who regularly provide behavioral health services (Behavioral Health Business summary of the final rule). Plans are measured on time and distance and on a minimum number of providers per county.

Humana's join page says it actively recruits psychiatrists, behavioral health and psychiatric nurse practitioners, psychologists, social workers, licensed professional counselors and licensed marriage and family therapists, along with other independently licensed behavioral health professionals. In your request, say which Texas counties you serve, whether you offer telehealth, and the populations you treat (older adults, substance use and co-occurring disorders, Spanish-language sessions). That's the network-need case.

Individual clinicians, step by step

1. Enroll in Medicare. File in PECOS for your own NPI, and reassign benefits to your group if you bill under one. Most Medicare Advantage plans expect it, and it puts you in a position to see original Medicare patients too.
2. Finish and attest CAQH ProView. Humana requires it. CAQH became DataSpring in 2026; the profile, login and 120-day attestation still work the same. Upload a current malpractice face sheet, explain any work-history gaps, and authorize Humana. Our CAQH ProView guide covers each section.
3. Send the Behavioral Health Provider Inquiry Form from Humana's Join our network page. Keep a copy and the date.
4. Register for Availity Essentials, Humana's provider portal, so you can check eligibility, request authorizations and see claims once you're in.
5. Answer credentialing requests fast. Humana verifies items such as your license, education, five-year work history and malpractice claims history. Humana's credentialing and recredentialing policy says practitioners must be credentialed before they provide care to members.
6. Read the contract before you sign: which Medicare Advantage products it covers (HMO, PPO, special needs plans), the rate for each code (often a percentage of the Medicare fee schedule), timely filing and the effective date.
7. See Humana members as in network only from the effective date in writing. Before that, a Humana PPO member may have out-of-network benefits; an HMO member usually doesn't.

Associates can't contract on their own: LPC Associates and LMFT Associates aren't independently licensed, and Medicare doesn't enroll them. See hiring and supervising associates for how practices handle that.

The Texas application notice

Humana's Credentialing in Texas page carries a notice from Humana Health Plan of Texas, Inc., an HMO in Austin, that it would accept written applications for its networks during a set period (the posted notice was for March 1 to March 20, 2024) and would notify applicants in writing of acceptance or non-acceptance within 90 days after receiving an application. In practice:

• Check the page for a current window when you apply, and send the behavioral health inquiry form either way.
• Put day 90 on your calendar from the date Humana received your application. No answer by then is a reason to call Provider Relations and ask for the status in writing.
• For HMO plans, Texas also caps how long initial credentialing can take; see TDI's HMO provider credentialing requirements.

Groups

A group needs its own Type 2 NPI and Tax ID, a Medicare group enrollment with each clinician's reassignment, and each clinician credentialed and linked to the group's contract, so claims pay the group. A clinician who joins later is added to the group's contract, not given a separate one. The Group Practice Launch does all of that for every clinician, and our guide to starting a group practice in Texas covers the entity decisions first.

IOP and PHP programs

This is where a Humana contract gets complicated for a freestanding Texas program, because Medicare Advantage plans start from Medicare's coverage rules:

• Medicare's IOP benefit began January 1, 2024. CMS's Benefit Policy Manual, chapter 6 covers IOP services furnished by hospitals, critical access hospitals, community mental health centers (CMHCs), rural health clinics, FQHCs and opioid treatment programs, for both mental health and substance use disorders. Hospitals and CMHCs bill on the institutional claim with condition code 92.
• Medicare PHP is likewise limited to hospital outpatient departments and CMHCs.
• A freestanding program licensed by HHSC isn't one of those provider types unless it is Medicare-certified, for example as a CMHC. So ask Humana directly whether it will contract your program, under which codes (H0015 or S9480 for IOP, H0035 for PHP, or revenue codes on a UB-04) and at what per diem, before you build a Humana census into your forecast.
• Have the facility packet ready: HHSC license covering every level of care, accreditation letter and survey report, Type 2 NPI, W-9, liability certificates, medical director's license, and a program description. Our guide to insurance contracts for treatment centers lists what to check in a facility contract.

If Humana won't contract the program, your clinicians can still be in network for professional services (individual and group therapy, psychiatric visits) billed under their own NPIs. For a Humana member who needs your program now, ask for a single case agreement in writing before admission.

After you're in: prior authorization

• Check the list. Humana's 2026 provider manual points to its online prior authorization list at Humana.com/PAL, which can change, and names behavioral health partial hospital and residential facilities among the services that need prior authorization. Humana's Medicare prior authorization and notification list includes behavioral health partial hospitalization.
• Ask early. The manual asks for requests as soon as possible and at least 14 days before the service, through Availity or by fax to the behavioral health line. Emergent and urgent care don't need prior authorization; services given without a required authorization can be reviewed afterward.
• Decision times are shorter in 2026. Under CMS's interoperability and prior authorization rule, Medicare Advantage plans must decide standard requests within 7 calendar days and expedited requests within 72 hours, starting in 2026 (CMS). If a standard request sits longer, escalate.
• Track every authorization's end date and send the concurrent review before it lapses. Our sister product's prior authorization guide walks through it, and Cima EHR's program plan tracks authorizations by client.

Recredentialing and upkeep

• Every 36 months, under Humana's credentialing policy (it may recredential telehealth practitioners more often).
• CAQH every 120 days. An unattested profile is the most common reason recredentialing stalls.
• Medicare revalidation. CMS revalidates Medicare enrollment on its own cycle; a deactivated Medicare enrollment causes Medicare Advantage claim problems too.
• Service areas. Each fall, check whether Humana still sells plans in your counties for the coming year, and tell clients in a plan that's ending before open enrollment closes so they can choose.

Credentialing upkeep, $49 per clinician a month, covers CAQH re-attestation, license and malpractice renewals, Medicare revalidation reminders and recredentialing for every plan.

How we work a Humana file

Why Humana files stall

1. Asking for a commercial contract Humana no longer offers.
2. No Medicare enrollment, or a Medicare enrollment that doesn't match the NPI and Tax ID on the Humana request.
3. CAQH not attested or not authorized for Humana.
4. An associate applying without an independent license.
5. A program that isn't a Medicare provider type applying for an IOP or PHP facility contract without first asking how Humana contracts it.
6. Applying where Humana doesn't need you, or in counties it's leaving. Make the network-need case in the inquiry.

If Humana says no for network need, ask for the reason in writing; our guide to getting in when a network is closed covers what to try next.

What we do, and what it costs

Cima Consulting files Humana the way this page describes: Medicare enrollment first, CAQH built and authorized, the inquiry sent with a real network-need case, follow-up every two weeks, and the contract checked before you sign. You sign every application and contract yourself.

Medicare enrollment is $350 per clinician and Humana is $175 per plan per clinician. A program contract is $450 per plan. Opening a practice? The Solo Practice Launch: Complete includes Medicare and your first plans.

Questions

Back to credentialing for Texas practices and programs, or read the VA Community Care guide.

Sources

All checked October 24, 2026. Humana and CMS revise these documents; open the current version before you rely on any detail.

1. Humana, Join our network (Behavioral Health Provider Inquiry Form). humana.com
2. Humana, Credentialing in Texas. humana.com
3. Humana, Credentialing and CAQH. humana.com
4. Humana, Credentialing and Recredentialing Policy (28th ed.). humana.com
5. Humana, 2026 Provider Manual (non-delegated). humana.com
6. Humana, Medicare and Dual Medicare-Medicaid Prior Authorization and Notification List (October 1, 2025). humana.com
7. Humana Inc., Form 10-K for fiscal year 2025. sec.gov
8. CMS, Medicare Benefit Policy Manual, chapter 6 (intensive outpatient program services). cms.gov
9. CMS, Improving prior authorization processes (CMS-0057-F). cms.gov
10. Behavioral Health Business, CMS finalizes new behavioral health policies in Medicare Advantage (April 5, 2024). bhbusiness.com
11. Texas Department of Insurance, HMO provider credentialing requirements. tdi.texas.gov
12. Medicare.gov, Medicare Plan Finder. medicare.gov

General information, not legal or billing advice. Cima Consulting isn't a law firm and isn't affiliated with Humana or CMS; Humana makes its own network decisions, and we don't guarantee a contract, rate or date.