Molina Healthcare of Texas credentialing for behavioral health providers and IOP/PHP programs

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

Molina at a glance

Where Molina serves, and why STAR+PLUS matters

On HHSC's managed care service areas map (the 2026 revisions), Molina appears in these areas:

Why this matters for an adult program: Texas didn't expand Medicaid, so most adult Medicaid clients are either in STAR (pregnant women and some parents) or STAR+PLUS (adults with disabilities and adults 65 and older). In the STAR+PLUS line-ups, Harris has Community Health Choice, Molina and UnitedHealthcare; Dallas has Molina, Superior and UnitedHealthcare; Tarrant has Molina and UnitedHealthcare; Jefferson has Molina and Wellpoint. Molina is the only plan on all four lists, so a DFW or Houston-area adult IOP that plans to serve STAR+PLUS members usually wants Molina early. Our city guides for Dallas, Fort Worth and Houston list the full local line-ups, and Texas Medicaid plans by area covers the rest of the state.

HHSC changes line-ups with its contracts. Open the current map for every county you serve before you count on Molina members there.

Before you apply

• TMHP enrollment in PEMS, with your Texas Provider Identifier. No Texas Medicaid plan credentials a provider who isn't enrolled. Our Texas Medicaid enrollment guide walks through PEMS.
• Medicare first for LPCs and LMFTs. Since March 1, 2024, Texas Medicaid has required LPCs and LMFTs to enroll in Medicare before Medicaid, unless they qualify for the pediatric exemption (a Texas Medicaid plan's reminder notice). See our Medicare guide for LPCs and LMFTs.
• CAQH ProView complete, attested and shared with Molina. Our CAQH ProView guide covers each section.
• For a program: the HHSC chemical dependency treatment facility license for each site, the organization NPI, liability certificates and an ownership chart. See how to get a Texas CDTF license.
• Matching data everywhere. Legal name, service address and Tax ID must match across the IRS letter, NPPES, PEMS, CAQH and the W-9. On the files we work, a mismatch is the most common reason a Medicaid plan sends an application back.

Step 1: the online application

Molina takes new providers through its Provider Network Management portal, which offers an online application and sends you to your state's own joining steps. In the application:

1. Pick Texas and the right provider type: an individual clinician, a clinician joining a group that already contracts with Molina, or a facility. A program applies as a facility and lists its levels of care (outpatient, IOP, PHP).
2. Name the products you want: STAR, STAR+PLUS and CHIP in your service area, and say whether you also want Molina's marketplace network (below). Ask whether behavioral health is open to new providers in your counties before you build the whole file.
3. Give the identifiers up front: Tax ID, individual and organization NPIs, Texas Provider Identifier, CAQH number and the exact service address.
4. Keep the confirmation and the date. Molina's Texas phone numbers differ between its documents, so log every contact with the name and date, and use the routes on Molina's current Texas provider page.

If Molina tells you a network is full in your area, ask for the answer in writing and whether it reconsiders when member access needs change. Our closed insurance network guide covers the letter and the Texas rules.

Step 2: verification and the review committee

Molina's Texas Medicaid and CHIP provider manual says its credentialing department verifies all the information on your application before contracting, re-verifies it every three years (or sooner under its criteria), and then presents the file to its Professional Review Committee, which decides whether you meet its standards (Molina Texas provider manual). The same manual has chapters on expedited credentialing and on your right to appeal an adverse credentialing decision.

The primary-source checks themselves don't happen at Molina. Since April 1, 2018, every Texas Medicaid plan has used one centralized, NCQA-certified CVO managed by the Texas Association of Health Plans (TAHP's Credentialing 101). That's good news if you're applying to several plans: the CVO verifies your license, education, sanctions and history once, and every plan uses the result. Molina's committee decision and contract are still Molina's alone.

Two things speed this step: an explanation in CAQH for anything in your history that needs one (a board order, a claim, a gap) before verification starts, and a quick answer when the CVO emails for a missing document. A file that waits on you doesn't move.

Joining a contracted group

Texas law requires every Medicaid plan to offer expedited credentialing: a clinician who joins an established group that already has a contract with the plan, is enrolled in Texas Medicaid, agrees to the group contract's terms and sends what the plan asks for on time can be treated as in network for Medicaid members while credentialing finishes (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. Molina's manual describes its own process; ask Molina for its expedited request form when the group adds the clinician, and don't schedule Molina members for the new clinician until Molina confirms the provisional status in writing.

The law also lets a plan recover payments from a provider who turns out not to meet its credentialing requirements and submitted fraudulent claims, so use this lane for clean files only. If you're building a group, our Group Practice Launch credentials every clinician on one roadmap.

For IOP and PHP programs

A program is credentialed as an organization. Molina's own Texas facility form wasn't published where we could verify it, so ask Molina which application it wants. Many Texas Medicaid plans take the Texas Association of Health Plans' standardized Texas Facility/Ancillary/Long-term Care Credentialing Application, whose instructions warn that changing its wording or format invalidates it. Have these ready either way:

Benefits to confirm before you count on the revenue. Molina's STAR+PLUS member benefits page lists partial hospitalization and intensive outpatient services under both mental health and substance use treatment (Molina STAR+PLUS behavioral health benefits). In Texas Medicaid, adult PHP and IOP are generally offered by plans "in lieu of" inpatient care rather than as standard benefits, and HHSC asks plans to bill them by HCPCS code; our Texas Medicaid IOP and PHP guide explains both. Ask Molina in writing which programs (STAR, STAR+PLUS) it pays PHP and IOP for, which codes and rates the contract uses (a per diem by HCPCS code is what other Texas plans' billing notices describe), and whether it also credentials your clinicians individually. Our guide to insurance contracts for treatment centers lists what to check before you sign.

After you're in: authorizations and the portal

• Prior authorization: Molina's Texas Medicaid prior authorization guide lists partial hospitalization among the behavioral health services that need authorization and points to a separate prior authorization code matrix for the exact codes (Molina Texas Medicaid PA guide, 2020). That guide is old; pull the current matrix before your first admission and check IOP codes (H0015, S9480) too.
• Portal: Molina names Availity Essentials as its secure provider portal for claims, claim status, corrections, appeals and authorizations, and a February 2026 Molina addendum says it is moving toward portal-only prior authorization submission in some markets (Molina addendum, February 2026). Register your organization on Availity before the effective date.
• Timely filing: take the number from your Molina contract. Texas Medicaid plans commonly use 95 days from the date of service (Superior and Community Health Choice both publish 95); our timely filing guide has the Texas rules.
• Eligibility every month: Texas Medicaid members can change plans, so check before each 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 approved units in your EHR before day one, and start 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 up before the claim does.

Molina's marketplace network

Molina has also sold marketplace (Affordable Care Act) plans in Texas, and its Texas marketplace materials list a separate contracting mailbox for joining that network (Molina Texas marketplace quick reference guide). Marketplace members aren't Medicaid members: they have deductibles, out-of-pocket maximums and their own authorization rules. If you want them, ask in your application whether Molina sells marketplace coverage in your counties for the coming plan year and make sure the contract lists the product; then verify benefits before each admission with our VOB checklist.

Why Molina files stall

• No TMHP enrollment yet, or an LPC or LMFT without Medicare enrollment.
• CAQH not attested or Molina not authorized to view it.
• Name, address or Tax ID mismatches between the W-9, NPPES, PEMS and CAQH.
• The wrong service area or product: asking for STAR in Tarrant, where Molina serves STAR+PLUS but not STAR.
• A facility file without the license for that address, or with levels of care the license doesn't list.
• Seeing members before the effective date outside an approved expedited request.
• PHP or IOP started without an authorization, or billed without the HCPCS code.

How we work a Molina file

On the Texas roadmaps we run, TMHP enrollment is budgeted at about 45 days and each Medicaid managed care plan at about 90 days after TMHP and CAQH are done; Molina can run longer. Our credentialing service checks Molina's line-up for your counties, files the application, answers the CVO, follows up every two weeks, reviews the contract and confirms the effective date in writing before the first claim. Prices:

• Texas Medicaid enrollment with your first managed care plan: $350 per clinician.
• Molina as an additional plan for a clinician: $175 per plan.
• A program's facility contract with Molina: $450 per plan.

For example, a Dallas-area SUD program going after the STAR+PLUS plans (Molina, Superior and UnitedHealthcare) as a facility, after TMHP: $1,250. Total your own plan list with the credentialing cost calculator, or have TMHP, Molina and the other plans carried on one dated roadmap in the IOP / PHP Program Launch.

Questions

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

Sources

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

1. Molina Healthcare of Texas, Medicaid/CHIP/MMP Provider Manual, 2024 (credentialing, Professional Review Committee, three-year re-verification, behavioral health, expedited credentialing, appeal rights). molinahealthcare.com
2. Molina Healthcare, Provider Network Management portal (online application, state selection). molinahealthcare.com
3. Molina Healthcare of Texas, STAR+PLUS Behavioral Health and Substance Use Disorders benefits. molinahealthcare.com
4. Molina Healthcare of Texas, Medicaid Prior Authorization Guide, 2020 Q2. molinahealthcare.com
5. Molina Healthcare, February 2026 addendum (Availity, portal-only prior authorization). molinahealthcare.com
6. Molina Healthcare of Texas, Marketplace Quick Reference Guide. molinahealthcare.com
7. Texas HHSC, Managed Care Service Areas map (2026 revisions). hhs.texas.gov
8. Texas Association of Health Plans, "Credentialing 101," Fall 2024. tahp.org
9. Texas Association of Health Plans, Texas Facility/Ancillary/Long-term Care Credentialing Application, 2023. tahp.org
10. Texas Government Code §540.0656, Expedited Credentialing Process for Certain Providers. law.justia.com
11. 1 Tex. Admin. Code §353.423, Expedited Credentialing. law.cornell.edu
12. Community Health Choice, "Reminder: LPC and LMFT Providers Must Enroll in Medicare Effective 03/01/2024." communityhealthchoice.org

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