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

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

PCHP at a glance

What changed on September 1, 2025

For years, PCHP's behavioral health benefit was run by Beacon Health Options, now Carelon Behavioral Health, which kept its own Parkland provider handbook and network. Carelon's Texas provider page now says that effective September 1, 2025, Carelon no longer manages the behavioral health benefit for PCHP, and it sends providers to PCHP's provider site (Carelon Texas forms and guides). PCHP told members that only the management of their behavioral health services changed, that their benefits stayed the same, and that from September 1 they would see providers in PCHP's network (PCHP benefits update).

What that means for you:

• A Carelon contract no longer puts you in PCHP's network. If you saw PCHP members through Carelon, confirm in writing that you hold a PCHP contract and an effective date. Claims for dates on or after September 1, 2025 under the old arrangement are the ones to check first.
• New providers apply to PCHP, not to Carelon. Carelon's Availity enrollment is for Carelon's own networks.
• Some PCHP pages still read the old way. PCHP's prior authorization page says instructions for behavioral health services come from its behavioral health delegate (PCHP prior authorization). Ask Provider Relations where behavioral health authorization requests go now, and keep the answer.

Our sister site's guide to behavioral health carve-outs explains how to tell, for any card, who manages the behavioral health benefit.

Where PCHP serves, and who it covers

PCHP serves Collin, Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall counties (Parkland Community Plan), HHSC's Dallas service area. Tarrant, Denton and the counties west of them are a different service area with different plans. On HHSC's managed care service areas map (2026 revisions):

• A Dallas adult SUD IOP: start with Molina (in both STAR and STAR+PLUS here), then Superior and UnitedHealthcare for STAR+PLUS; add PCHP for the pregnant women and parents in STAR. See our Dallas IOP guide and Plano and Frisco guide.
• An adolescent program: PCHP's STAR and CHIP members are your population, alongside Molina and Wellpoint. See how to run an adolescent IOP in Texas.
• A pregnant and postpartum program: PCHP's STAR and CHIP Perinatal members matter most. See our women's and perinatal program guide.

Before you apply

• TMHP enrollment in PEMS, with your Texas Provider Identifier. PCHP's credentialing page makes Medicaid enrollment one of the three conditions for payment (PCHP provider credentialing). 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). See our Medicare guide for LPCs and LMFTs.
• CAQH ProView complete and attested. Our CAQH ProView guide covers each section.
• 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.
• Matching data everywhere. Legal name, service address and Tax ID must match across the IRS letter, NPPES, PEMS, CAQH and the W-9.

Step by step

1. Get the form. PCHP's Join Our Network page asks interested providers to complete its form and mail or email it to Attn: Network Development, 1341 West Mockingbird Lane, Suite 400E, Dallas, TX 75247. Its provider manual calls it the Prospective Provider Form and lists Provider Relations at PCHP.ProviderRelations@phhs.org.
2. Say exactly what you want: STAR, CHIP or both; individual, group or facility; each service address in the seven counties; your behavioral health specialty and the ages you treat. Ask whether the behavioral health network is open for your specialty.
3. Make CAQH available to PCHP and send what its credentialing team asks for. PCHP says its process follows NCQA, Texas Department of Insurance and HHSC guidelines, and every office-based practitioner in its STAR and CHIP networks goes through full credentialing.
4. Answer the CVO. All Texas Medicaid plans use one centralized credentialing verification organization managed by the Texas Association of Health Plans, which verifies your license, education and history once for every plan (TAHP's Credentialing 101). Reply to its requests the same day.
5. Sign the contract and get the effective date in writing. PCHP pays only when Medicaid enrollment, initial credentialing and the signed contract are all in place.

PCHP 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; a plan rebuilding its behavioral health network can move faster or slower, so follow up every two weeks.

Expedited credentialing

PCHP's credentialing page offers expedited credentialing under Texas Insurance Code Chapter 1452 to physicians, podiatrists and therapeutic optometrists. Behavioral health clinicians have their own route: HHSC's rule requires every Medicaid plan to run an expedited process for licensed clinical social workers, licensed professional counselors, licensed marriage and family therapists and psychologists who join a group that already contracts with the plan (1 TAC §353.423; Texas Government Code §540.0656). The clinician must be enrolled in Texas Medicaid, agree to the group contract's terms and send what PCHP requires on time. Ask PCHP for its expedited request in the same submission that adds the clinician, and don't schedule members until PCHP 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 PCHP 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.

Benefits to confirm. PCHP's adult members are in STAR, mostly pregnant women and parents. In Texas Medicaid, adult PHP and IOP are generally offered by plans "in lieu of" inpatient care rather than as standard benefits, and billed by HCPCS code (H0035 for PHP; H0015 and S9480 for IOP); our Texas Medicaid IOP and PHP guide explains both. Ask PCHP in writing whether it offers PHP and IOP that way, for which ages, and the codes and rates in your contract. Our guide to insurance contracts for treatment centers lists the rest of what to check.

After you're in: auths and claims

• Prior authorization: PCHP's prior authorization lookup tool checks codes; confirm the behavioral health route with Provider Relations, as above.
• Claims: PCHP takes electronic claims as EDI X12 837 5010 transactions to payer ID 66917 (PCHP claims submission). 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.
• Eligibility every month: Medicaid and CHIP 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 PCHP files stall

• Applying to Carelon for PCHP members, or relying on a pre-September 2025 Carelon contract.
• No TMHP enrollment yet, or an LPC or LMFT without Medicare or the pediatric exemption.
• A site outside the seven counties; Tarrant and Denton are a different service area.
• Asking for STAR+PLUS, which PCHP doesn't offer.
• CAQH not attested or PCHP not authorized to view it.
• Seeing members before the effective date outside an approved expedited request.

How we work a PCHP file

Our credentialing service enrolls you with TMHP, sends PCHP's prospective provider form with the right programs and sites, 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 (PCHP or another): $500 per clinician.
• PCHP as an additional plan for a clinician: $275 per plan.
• A program's facility contract with PCHP: $950 per plan.

For example, a Dallas adolescent program enrolling with TMHP and contracting with PCHP, Molina and Wellpoint 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: Molina · Wellpoint Texas · Superior HealthPlan · UnitedHealthcare / Optum · Texas Children's Health Plan · El Paso Health · Driscoll 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. Parkland Community Health Plan, Join Our Network (form, Network Development address). parklandhealthplan.com
2. Parkland Community Health Plan, Provider Credentialing (conditions for payment, NCQA/TDI/HHSC, expedited credentialing). parklandhealthplan.com
3. Parkland Community Health Plan, Provider Manual (Prospective Provider Form, Provider Relations). parklandhealthplan.com
4. Parkland Community Health Plan, "PCHP Benefits Update: Changes to Behavioral Health Services." parklandhealthplan.com
5. Parkland Community Health Plan, Prior Authorization. parklandhealthplan.com
6. Parkland Community Health Plan, Prior Authorization Lookup Tool. parklandhealthplan.com
7. Parkland Community Health Plan, Claims Information for Providers (payer ID 66917). parklandhealthplan.com
8. Parkland Health, Parkland Community Plan (founding, HEALTHfirst and KIDSfirst, counties). parklandhealth.org
9. Carelon Behavioral Health, Texas forms and guides (end of Parkland management, September 1, 2025). carelonbehavioralhealth.com
10. Texas HHSC, Managed Care Service Areas map (2026 revisions). hhs.texas.gov
11. Texas Association of Health Plans, "Credentialing 101," Fall 2024. tahp.org
12. Texas Association of Health Plans, Texas Facility/Ancillary/Long-term Care Credentialing Application, 2023. tahp.org
13. 1 Tex. Admin. Code §353.423, Expedited Credentialing. law.cornell.edu
14. Texas Government Code §540.0656, Expedited Credentialing Process for Certain Providers. law.justia.com
15. Blue Cross and Blue Shield of Texas Medicaid, "Reminder: Medicare Requires LPC and LMFT Enrollment," May 14, 2024. bcbstx.com

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