Superior HealthPlan credentialing for behavioral health providers and IOP/PHP programs

Part of our credentialing guide for Texas practices and programs. Other Texas plans: Wellpoint Texas · every Texas Medicaid plan.

Superior at a glance

Question	Answer
Who it is	A Centene health plan serving Texas Medicaid (STAR, STAR+PLUS, STAR Kids), CHIP and STAR Health, the statewide plan for children in foster care.
First step	TMHP enrollment, then a Network Participation Request at superiorhealthplan.com (the "Join our network" / "Become a provider" page).
Clinicians	A complete CAQH ProView profile, re-attested every 120 days. Superior's forms page says Verisys, the CVO, helps with credentialing and primary-source verification.
IOP / PHP programs	The Behavioral Health Facility and Ancillary Credentialing Application, one per facility, plus the ownership disclosure, a roster and a signed W-9.
Faster lane	Expedited credentialing for LCSWs, LPCs, LMFTs and psychologists joining a group that already has a Superior contract.
Behavioral health	Run by Superior's own behavioral health team, with its own claims payer ID (68068) and prior authorization line.
Portal	Superior's Secure Provider Portal (Provider.SuperiorHealthPlan.com): eligibility, claims, authorizations and patient lists.

What Superior covers and who runs behavioral health

Superior covers a large share of Texas. On HHSC's managed care service areas map, when we checked, it appeared for STAR in Bexar, El Paso, Hidalgo, Lubbock, Nueces and Travis, for CHIP in most of those and the rural West, and it is the only plan for STAR Health statewide. Superior lists its STAR Kids areas as Bexar, El Paso, Hidalgo, Lubbock, MRSA West, Nueces and Travis (Superior's STAR Kids page). Line-ups change with HHSC's contracts, so check the map for every county you serve before you count on Superior members.

Behavioral health stays inside Superior. Its billing training sends behavioral health claims to a separate payer ID (68068, versus 68069 for medical), behavioral health authorizations go to a behavioral health utilization team, and behavioral health providers have their own account management team (Superior's behavioral health billing clinic). There's no separate behavioral health company to join, unlike plans that carve behavioral health out; our sister site explains behavioral health carve-outs for the plans that do.

Before you apply

Superior's network is a Medicaid network, so the state's rules come first. Have these done or under way:

• TMHP enrollment in PEMS, with your Texas Provider Identifier. LPCs and LMFTs must enroll in Medicare first (or claim the pediatric exemption). Our Texas Medicaid guide walks through PEMS, and the Medicare guide for LPCs and LMFTs covers PECOS.
• The minimums Superior lists: a current, valid Texas license, professional liability insurance at the limits your license type requires, and an individual NPI (Superior's behavioral health credentialing FAQ).
• A finished CAQH ProView profile, attested, with Superior authorized to view it. Our CAQH ProView guide covers every section.
• For a program: the HHSC license (a Texas SUD program is a licensed chemical dependency treatment facility), the organization NPI, liability certificates, and an ownership chart naming everyone with 5% or more. See how to get a Texas CDTF license.

Every name, address and Tax ID must match across the IRS letter, NPPES, TMHP, 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: send the Network Participation Request

Non-contracted providers start on Superior's network request page, which says to allow up to 30 days for Superior to evaluate and answer the inquiry. Superior's behavioral health quick reference guide points to SuperiorHealthPlan.com/JoinOurNetwork for the request and to its network development mailbox for contracting questions (Superior's behavioral health quick reference guide).

1. Say exactly what you are: an individual clinician, a group adding a clinician, or a facility (and which levels of care: outpatient, IOP, PHP).
2. Name the products you want: STAR, STAR+PLUS, STAR Kids, CHIP, and Ambetter if you also want marketplace members. Ask which are open to new behavioral health providers in your service area.
3. Attach the Tax ID, NPIs, TMHP number and service address, so the request isn't parked waiting for basics.
4. Log the date you sent it. If there's no answer after the 30 days Superior gives itself, follow up with network development.

If Superior says the panel is closed in your area, ask for the reason in writing and whether a network need exception applies. Our guide to closed insurance networks covers the letter and the Texas rules.

Step 2 for clinicians: CAQH and the Texas CVO

Superior credentials clinicians from CAQH. Its behavioral health FAQ says you need a CAQH profile before applying, must tell Superior when the application is complete, and must re-attest or update every 120 days. Superior's provider forms page says Verisys, the credentialing verification organization, assists with Superior's credentialing: Verisys pulls the CAQH data and does the primary-source verification. The forms page also points paper filers to the Texas Standardized Credentialing Application on the Texas Department of Insurance site.

That CVO isn't Superior's alone. Since April 1, 2018, every Texas Medicaid managed care plan has used one centralized, NCQA-certified CVO managed by the Texas Association of Health Plans (TAHP's Credentialing 101; Superior's CVO presentation). The verification is shared; Superior's application, committee decision and contract are still separate from every other plan's.

Superior checks backgrounds through primary sources such as state licensing boards, the National Practitioner Data Bank and the HHS Office of Inspector General at credentialing and recredentialing, and it publishes providers' rights to review and correct what it finds (Superior's credentialing rights notice). If something in your history needs explaining, put the explanation in CAQH before the verification starts.

Joining a group: expedited credentialing

Texas law requires every Medicaid managed care plan to run an expedited credentialing process that lets certain providers see members provisionally while credentialing finishes (Texas Government Code §540.0656; the HHSC rule is 1 TAC §353.423). Superior's expedited credentialing guide lists LCSWs, LPCs, LMFTs and psychologists among the eligible types. To use it:

• The clinician joins a group that already has a Superior contract, and the group submits a contract request to add them.
• The clinician is enrolled in Texas Medicaid, holds a Texas license in good standing, and signs an attestation agreeing to the group's contract.
• Superior reviews five years of malpractice history (or National Practitioner Data Bank results) and checks for federal program exclusion.

The law lets a plan recover payments if a provider turns out not to meet its credentialing requirements and submitted fraudulent claims, so this lane is for clean files. LCDCs aren't on Superior's list; in Texas Medicaid, substance use counseling is billed through the licensed facility they work for. Clinicians added through a local mental health authority roster follow a different Superior process that includes a DFPS central registry check (Superior's LMHA credentialing guide).

Step 2 for IOP and PHP programs

A program is credentialed as an organization. Superior's quick reference guide lists the facility packet: the Network Participation Form with the Behavioral Health Facility and Ancillary Credentialing Application, a Disclosure of Ownership and Control Interest Statement, a roster form, and a signed, dated W-9 showing the IRS-registered legal name and billing address. A separate application is needed for each facility.

Item	What Superior asks for	Where programs slip
Facility application	One per facility (each site with its own license or Tax ID)	Filing one application for two sites, or listing services the license doesn't cover
License	The HHSC facility license for the address	Applying before the license issues; Superior and TMHP both need it
Accreditation	Listed on the application checklist; send it if you have it	Ask whether Superior will contract before accreditation for your level of care
Medicaid and Medicare numbers	Your TMHP enrollment (and Medicare, if enrolled)	A TMHP application still pending
Ownership disclosure	Everyone with ownership or control interest	Owners missing from TMHP but listed here, or the reverse
Roster and W-9	Clinicians who'll serve members; W-9 matching the IRS name	A DBA on the W-9 instead of the legal name

Ask in the request whether Superior will also credential your clinicians individually and which rate methodology it will offer for PHP and IOP days (per diem by HCPCS code, as below, is what Superior's billing notices describe). Our guide to insurance contracts for treatment centers covers the facility packet, site visits and what to check in the contract before you sign.

After you're in: Superior's PHP and IOP rules

Texas Medicaid doesn't treat adult PHP and IOP as ordinary benefits. HHSC lets plans offer them "in lieu of" inpatient psychiatric care (see our Texas Medicaid IOP and PHP guide). Here's how Superior applies that:

• Who: Superior offers mental health and substance use PHP and IOP to adult members over 20 in STAR, STAR+PLUS and STAR Health as in-lieu-of services; members under 21 can get them through Texas Health Steps (EPSDT) (Superior's PHP and IOP notice).
• Prior authorization: required for PHP and IOP, submitted no less than five business days before services start, and approval isn't a guarantee of payment. IOP (mental health and SUD) is on Superior's Medicaid prior authorization list.
• Clinical documentation: Superior's PHP/IOP provider checklist takes requests by fax or the Secure Provider Portal; for substance use it asks for history including the longest sobriety, treatment history, the treatment plan, drug screens and a discharge plan.
• Codes: since July 1, 2025, adult PHP and IOP claims must carry the HCPCS code, with the revenue code optional: PHP 0912 with H0035 (less intensive) or 0913 with S0201 (intensive); IOP 0905 with S9480 (psychiatric) or 0906 with H0015 (chemical dependency) (Superior's billing code update, September 2025). Our sister site's IOP and PHP billing codes guide explains each one.

Put the authorization number, dates and approved units in your EHR before day one, and start the concurrent review well before the last approved day. Our utilization review guide lays out the authorization log and review timing.

The portal, claims and payer IDs

• Secure Provider Portal at Provider.SuperiorHealthPlan.com: register with your TIN, name, email and a password. Contracted providers can register right away; non-contracted providers after their first claim (Superior's portal training).
• Payer IDs: 68068 for behavioral health claims, 68069 for medical. A behavioral health claim sent to the medical ID is a self-inflicted rejection.
• Timely filing: Superior's behavioral health billing training lists 95 days from the date of service. Confirm the number in your contract; our timely filing guide has the Texas rules.
• Eligibility: Superior's training says to check it on the first of each month. Texas Medicaid members can change plans, so check before every admission and each month after.

Ambetter (marketplace)

Superior also sells marketplace (Affordable Care Act) coverage in Texas under the Ambetter name. Marketplace members aren't Medicaid members: they have deductibles and out-of-pocket maximums, and their own network and authorization rules. When you send the Network Participation Request, say whether you want Ambetter too, and check that the contract you're offered lists it. Before admitting an Ambetter member, verify benefits like any commercial plan; our VOB checklist lists the questions.

Why Superior files stall or deny

• No TMHP enrollment yet, or an LPC or LMFT without Medicare enrollment.
• CAQH not attested, Superior not authorized to view it, or Superior never told the application is complete.
• Name, address or Tax ID mismatch between the W-9, NPPES, TMHP and CAQH.
• A facility application without the license for that address, or one application covering two sites.
• Seeing members before the effective date. Outside expedited credentialing, services before your effective date aren't in network.
• PHP or IOP claims without the HCPCS code, or without an authorization requested five business days ahead.
• Claims to the wrong payer ID (medical instead of behavioral health).

How we work a Superior file

On the Texas roadmaps we run, Medicaid managed care applications wait for TMHP and a finished CAQH profile, and we budget about 90 days for them. Our credentialing service sends the request, builds or fixes CAQH, files the clinician or facility application, 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 (often Superior): $350 per clinician.
• Each additional plan for a clinician: $175 per plan.
• A program's facility contract with Superior: $450 per plan.

Service	Price
Medicaid enrollment State Medicaid enrollment and the first managed care plan. Includes: State enrollment (Texas: TMHP); One Medicaid managed care plan; Revalidation date tracked.	$350 per clinician
Credentialing: one insurance plan One clinician with one insurance plan, from application to effective date. Includes: Application filed; Follow-up every 2 weeks until decided; Contract review checklist (rates, timely filing, termination); Effective date confirmed and loaded in your EHR.	$175 per plan
Facility or group contract: one plan A program or group contract with one insurance plan: the organization application, site visit and contract. Includes: Organization application; Site visit preparation if the plan does one; Contract and rate review checklist; Effective date and billing set-up confirmed.	$450 per plan

For example, an LPC who already has Medicare and wants TMHP, Superior and one more Medicaid plan, with CAQH built: $775 in all. A new SUD program gets TMHP, the Superior facility contract and the other plans on one dated roadmap in the IOP / PHP Program Launch.

Questions

How do I join Superior HealthPlan as a behavioral health provider?

Enroll in Texas Medicaid through TMHP, finish and attest your CAQH profile, then send Superior a Network Participation Request from its "Join our network" page. Superior says to allow up to 30 days for an answer. Clinicians are then credentialed from CAQH through the Texas CVO; programs file the Behavioral Health Facility and Ancillary Credentialing Application.

Does Superior HealthPlan use CAQH?

Yes. Superior's behavioral health FAQ says you need a CAQH profile before applying and must re-attest every 120 days. Verisys, the Texas Medicaid CVO, pulls CAQH data and does the primary-source checks.

Who manages behavioral health for Superior HealthPlan?

Superior does. Behavioral health has its own payer ID (68068), prior authorization team and account management team, but you contract with Superior itself.

Does Superior cover IOP and PHP for adults?

Yes, as in-lieu-of services for adult members over 20 in STAR, STAR+PLUS and STAR Health, with prior authorization at least five business days before services start. Members under 21 can get them through Texas Health Steps.

Can a new clinician see Superior members before credentialing finishes?

Only through expedited credentialing: an LCSW, LPC, LMFT or psychologist joining a group that already has a Superior contract, who is Medicaid-enrolled and meets Superior's conditions. Otherwise wait for the effective date.

How long does Superior credentialing take?

Superior allows up to 30 days to answer the network request. Credentialing and contracting come after that; we budget about 90 days for a Medicaid plan once TMHP and CAQH are done, and it can run longer.

Is Ambetter the same as Superior?

Ambetter is the marketplace plan Superior sells in Texas. It isn't Medicaid, so its members have deductibles and their own network rules. Ask for Ambetter in your request and check the contract lists it.

More Texas plan guides: Wellpoint Texas · Texas Medicaid plans by area · Texas Medicaid for IOP and PHP · TMHP enrollment · 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. Superior HealthPlan, "Network Request or Update" (become a provider; up to 30 days). superiorhealthplan.com
2. Superior HealthPlan, Behavioral Health Credentialing FAQ (2017): minimum requirements, CAQH, 120-day re-attestation. superiorhealthplan.com
3. Superior HealthPlan, Behavioral Health Provider Quick Reference Guide (JoinOurNetwork, facility packet). superiorhealthplan.com
4. Superior HealthPlan, Behavioral Health Facility and Ancillary Credentialing Application. superiorhealthplan.com
5. Superior HealthPlan, Provider Forms (Verisys CVO; Texas Standardized Credentialing Application). superiorhealthplan.com
6. Superior HealthPlan, CVO provider presentation (centralized CVO from April 1, 2018). superiorhealthplan.com
7. Texas Association of Health Plans, "Credentialing 101," Fall 2024. tahp.org
8. Superior HealthPlan, Provider Credentialing Information and Rights, May 2024. superiorhealthplan.com
9. Superior HealthPlan, Expedited Credentialing guide. superiorhealthplan.com
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. Superior HealthPlan, Local Mental Health Authorities Credentialing Process QRG. superiorhealthplan.com
13. Superior HealthPlan, "Medicaid Partial Hospitalization Program and Intensive Outpatient Program MH and SUD Services Available." superiorhealthplan.com
14. Superior HealthPlan, Medicaid Prior Authorization List. superiorhealthplan.com
15. Superior HealthPlan, BH PHP/IOP Provider Checklist (2021). superiorhealthplan.com
16. Superior HealthPlan, "Behavioral Health PHP and IOP Billing Code Update," September 11, 2025. superiorhealthplan.com
17. Superior HealthPlan, Medicaid Behavioral Health Billing Clinic (payer IDs, timely filing, eligibility). superiorhealthplan.com
18. Superior HealthPlan, Secure Provider Portal training. superiorhealthplan.com
19. Superior HealthPlan, STAR Kids (service areas). superiorhealthplan.com
20. Texas HHSC, Managed Care Service Areas map. hhs.texas.gov

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