Texas Children's Health Plan credentialing for behavioral health providers and IOP/PHP programs

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

TCHP at a glance

Question	Answer
Who it is	Texas Children's Health Plan, the Medicaid and CHIP managed care plan of Texas Children's in Houston.
Programs	STAR, CHIP and STAR Kids, in the Harris, Jefferson and Northeast Texas service areas (TCHP's own description; check HHSC's map for each program by county).
Before anything	TMHP enrollment in PEMS, with the Medicare step or the pediatric exemption for LPCs and LMFTs, and an attested CAQH ProView profile.
How to apply	An account on TCHP's Cobblestone Gateway, then a new provider agreement request. The Gateway also takes roster updates and credentialing submissions.
Verification	Verisys, the state-mandated Texas Medicaid CVO; then TCHP's credentialing committee.
Behavioral health	Reviewed by TCHP's own utilization management department and behavioral health medical director, per its level-of-care guideline. We found no separate behavioral health company.
Claims	95 days from the date of service; payer ID 75228 for STAR and 76048 for CHIP.

Where TCHP serves, and who it covers

TCHP describes itself as serving CHIP, STAR and STAR Kids members in the Harris, Jefferson and Northeast service areas. On HHSC's managed care service areas map (2026 revisions), it appears alongside these plans:

Service area	Main counties	Other STAR plans there	STAR+PLUS (adults) there
Harris (Houston)	Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller, Wharton	Community Health Choice, Molina, UnitedHealthcare, Wellpoint	Community Health Choice, Molina, UnitedHealthcare (not TCHP)
Jefferson (Beaumont)	Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler, Walker	Community Health Choice, Molina, UnitedHealthcare, Wellpoint	Molina, Wellpoint (not TCHP)
Northeast Texas	East Texas counties from Bowie and Cooke south through the Tyler area, listed in TCHP's STAR Kids provider manual	HHSC's STAR chart for the rural Northeast lists Superior and Wellpoint; TCHP's manual lists the area for STAR Kids	Not TCHP

Who that means. STAR covers most children, pregnant women and some parents; CHIP covers children in families that earn too much for Medicaid, plus CHIP Perinatal; STAR Kids covers children and young adults with disabilities. TCHP's president described its members as 425,000 children and pregnant women when the plan challenged the state's 2024 contract awards (Fierce Healthcare). TCHP isn't a STAR+PLUS plan, so it doesn't cover adults with disabilities or adults 65 and older.

• An adolescent IOP or PHP in Houston or Beaumont: TCHP is one of the first plans to apply to, with Wellpoint and UnitedHealthcare. See how to run an adolescent IOP in Texas.
• A pregnant and postpartum program: TCHP's STAR and CHIP Perinatal members are your population. See our women's and perinatal program guide.
• An adult-only SUD IOP: start with the STAR+PLUS plans instead (Community Health Choice, Molina and UnitedHealthcare in Harris) and add TCHP later for pregnant STAR members. Our Houston IOP guide and Beaumont guide list the local line-ups.

Contract status: HHSC's 2024 tentative STAR and CHIP awards left Texas Children's out (Texas Tribune), and a Travis County judge then paused that procurement after a suit by plans including TCHP (Fierce Healthcare). We found no final new contracts, and TCHP is on HHSC's 2026 map. Check HHSC's current map before you build a program around any one plan.

Before you apply

• TMHP enrollment in PEMS, with your Texas Provider Identifier. Texas Medicaid plans credential providers who are already enrolled; 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 obtain a pediatric practice exemption, claimed in the program-specific questions of the PEMS record. A pediatric LPC or LMFT enrolling through a Medicare-enrolled group must enroll in Medicare too (BCBSTX Medicaid notice, 2024). For a children's plan like TCHP, the exemption is often the route; our Medicare guide for LPCs and LMFTs covers both.
• CAQH ProView complete, attested and shared with TCHP. TCHP's credentialing staff read your CAQH application when they check status; our CAQH ProView guide covers each section.
• For a program: the HHSC license for each site, covering the ages you treat, 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. TCHP lists "discrepancies with state enrollment" among the things it can tell you are delaying a file.

PEMS credentialing is rolling out. HHSC planned to let providers start managed care credentialing inside PEMS; TCHP's provider alert says the update was postponed in May 2025 (TCHP alert), and a December 2025 Texas plan notice described a soft launch for facility credentialing (Community Health Choice notice). Ask TCHP whether to start in PEMS or the Gateway when you file.

Step by step: the Cobblestone Gateway

In November 2023 TCHP moved contracting to the Cobblestone Gateway, used by new and existing providers to express interest in joining, submit practitioner credentialing, update rosters and change current agreements (TCHP provider alert). Its Becoming a Participating Provider page links the Gateway and its user guide.

1. Create a new provider account on the Gateway, using the legal name and Tax ID exactly as they appear on your W-9.
2. Wait for activation, then about ten minutes, before you submit a new provider agreement request; TCHP's alert says to wait after the account activates.
3. Submit the request as an individual, a group or a facility. Name the programs you want (STAR, CHIP, STAR Kids), each service location, your specialty (mental health, substance use or both) and the ages you treat.
4. Make CAQH available to TCHP for each clinician; programs send the facility application TCHP asks for (see below).
5. Answer Verisys when it writes for a missing item; TCHP stresses quick replies to Verisys correspondence.
6. Sign the agreement and get the effective date in writing before you schedule TCHP members. A Provider Relations Manager then contacts new providers to schedule an in-service on TCHP's policies.

Contracting questions went to 832-828-1004, option 6, or TCHPNetworkManagement@texaschildrens.org on TCHP's 2024 contact guide (TCHP quick reference contact guide). Confirm them on TCHP's current page.

Verisys, status and corrections

TCHP names Verisys Corp. as its credentialing verification organization. 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), so if Verisys already verified you for Community Health Choice or Molina, TCHP uses the same verification. TCHP's committee decision and contract are still its own.

• Status: once staff confirm your application is complete and know when the committee will review it, TCHP emails you your status. Calls to the provider line about status are forwarded to the credentialing department.
• Your rights: you can review information from outside sources used to evaluate your application and correct errors. Corrections go in writing to TCHP's Credentialing Department at credentialingresponse@texaschildrens.org within 10 days, per TCHP's provider information form. TCHP can't share material protected by peer review law, such as National Practitioner Data Bank results.
• Timeline: TCHP doesn't publish a fixed number. On our Texas roadmaps we budget about 90 days for a Medicaid plan after TMHP and CAQH are done.

Joining a contracted group

Texas law requires every Medicaid plan to offer expedited credentialing: a clinician who joins an established group that already contracts with the plan, is enrolled in Texas Medicaid, agrees to the group contract's terms and sends what the plan requires on time can be treated as in network for Medicaid members while credentialing finishes (Texas Government Code §540.0656; 1 TAC §353.423). At TCHP the group adds the clinician through the Gateway's roster and credentialing functions; ask for the expedited status in the same submission and wait for TCHP's written confirmation before you schedule members. Building a group? Our Group Practice Launch carries every clinician's plans on one roadmap.

For IOP and PHP programs

A program is credentialed as an organization. TCHP didn't publish a separate behavioral health facility form where we could verify it, so ask which application it wants. Many Texas Medicaid plans take the Texas Association of Health Plans' standardized Texas Facility/Ancillary/Long-term Care Credentialing Application; don't change its wording or format, which its instructions say invalidates it.

Item	What to send	Where programs slip
License	The HHSC license for each site, with the services and ages you'll treat	An adult-only license on a file for adolescent services
TMHP enrollment	The facility's Texas Provider Identifier	Filing on the Gateway while PEMS is still pending
Accreditation	Joint Commission or CARF letter, if you have one	Not asking whether TCHP contracts before accreditation
In-lieu-of attestation	TCHP's attestation to take part in in-lieu-of services, if you'll offer PHP or IOP that way	Starting in-lieu-of admissions without it on file
Roster, W-9, insurance	Clinicians who will serve members; W-9 with the IRS legal name; liability certificates	A DBA on the W-9 instead of the legal name

In-lieu-of services. TCHP's April 2025 alert, effective May 1, 2025, lists partial hospitalization and intensive outpatient programs as HHSC-approved alternatives a member can choose instead of acute inpatient care, for example after an inpatient psychiatric or substance use stay or when outpatient care hasn't worked. Members aren't required to use them, prior authorization is required, and providers sign an attestation agreeing to take part (TCHP in-lieu-of services alert). Our Texas Medicaid IOP and PHP guide explains how in-lieu-of services work across Texas plans. Ask TCHP in writing which members (by program and age) your contract covers for PHP and IOP, the codes and the rates before you count on the revenue; our guide to insurance contracts for treatment centers lists the rest of what to check.

Behavioral health authorizations

• What needs one: TCHP's April 2025 prior authorization requirements list mental health IOP, mental health PHP, substance use IOP and SUD PHP among the services that need authorization. Check the per-program columns on the current list before your first admission.
• Who reviews: TCHP's behavioral health level-of-care guideline (version 8, March 2025) covers authorization of inpatient, residential, partial hospitalization and intensive outpatient care. Its Utilization Management Department takes requests online, by fax, phone or mail, and requests that don't meet the guideline go to a behavioral health medical director or physician reviewer.
• How fast: the guideline says routine requests are decided within 3 business days of receipt and urgent requests within 1 business day. If TCHP asks for more clinical information, you have 3 business days from the date of its letter.
• Where to send: the provider portal, or the behavioral health fax at 832-825-8767 (toll-free 1-844-291-7505) listed on TCHP's prior authorization page. In-lieu-of requests should carry the information Uniform Managed Care Manual chapter 3.22 requires, plus clinical documentation.

Put the authorization number, dates and approved units in your EHR before day one, and send 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.

Claims: payer IDs and 95 days

• Timely filing: TCHP's FY26 STAR/CHIP provider manual sets the claims deadline at 95 days from the date of service, with corrected claims and appeals within 120 days of the last disposition (TCHP FY26 provider manual). Mark resubmissions "CORRECTED CLAIM." Our timely filing guide has the Texas rules.
• Payer IDs: STAR 75228 and CHIP 76048 on TCHP's quick reference guides; its 2024 guides point electronic submission to Availity Essentials.
• 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.

The contract question

Before you sign, get these answers in writing: which programs the agreement covers (STAR, CHIP, STAR Kids) and in which service areas; whether your clinicians are credentialed individually under the facility; how TCHP pays PHP and IOP (per diem by HCPCS code, such as H0035, H0015 and S9480, or another method); and whether the in-lieu-of attestation is part of the agreement. If TCHP tells you its network is full for your specialty or area, ask for that in writing; our closed insurance network guide covers what to do next, and a single case agreement can bridge one client.

Why TCHP files stall

• No TMHP enrollment yet, or an LPC or LMFT without Medicare or the pediatric exemption in PEMS.
• A Gateway request submitted before the account activated, or under a name that doesn't match the W-9.
• CAQH not attested or TCHP not authorized to view it.
• Slow answers to Verisys, which TCHP names as a cause of delay.
• A facility license that doesn't cover the ages or levels of care on the application.
• PHP or IOP started without authorization, or an in-lieu-of admission without the attestation.
• Seeing members before the effective date outside an approved expedited request.

How we work a TCHP file

Our credentialing service checks TCHP's programs in your counties, enrolls you with TMHP, sets up the Gateway account, files the request, answers Verisys, follows up every two weeks, reviews the agreement 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 (TCHP or another): $500 per clinician.
• TCHP as an additional plan for a clinician: $275 per plan.
• A program's facility contract with TCHP: $950 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.	$500 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.	$275 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.	$950 per plan

For example, a Houston adolescent IOP enrolling with TMHP and then contracting with TCHP, Wellpoint and UnitedHealthcare 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

How do I become a Texas Children's Health Plan provider?

Enroll in Texas Medicaid through TMHP, finish and attest CAQH, then create an account on TCHP's Cobblestone Gateway and submit a new provider agreement request. Verisys verifies your file, TCHP's credentialing committee decides, and you're in network from the effective date on your signed agreement.

What is the TCHP Cobblestone Gateway?

TCHP's contracting platform since November 2023. New providers use it to request to join, and contracted providers use it for credentialing submissions, roster updates and changes to their agreements. Create the account first and wait for activation before submitting a request.

Who does credentialing for Texas Children's Health Plan?

Verisys, the Texas Medicaid credentialing verification organization, does the primary-source verification. TCHP's own credentialing department and committee make the decision and email you your status.

Does Texas Children's Health Plan cover adults?

Mostly children and pregnant women. STAR includes pregnant women and some parents, and CHIP Perinatal covers pregnancies, but TCHP isn't a STAR+PLUS plan, so adults with disabilities and adults 65 and older are with other plans.

Does TCHP require prior authorization for IOP and PHP?

Yes. Its April 2025 list includes mental health and substance use IOP and PHP, and its in-lieu-of services alert requires authorization for PHP and IOP offered in place of inpatient care. Routine requests are decided within 3 business days.

What is TCHP's timely filing limit?

95 days from the date of service, per its FY26 STAR/CHIP provider manual, with corrected claims and appeals within 120 days of the last disposition. Check your agreement.

Do LPCs need Medicare to join TCHP?

Texas Medicaid requires LPCs and LMFTs to enroll in Medicare or claim the pediatric practice exemption in PEMS before Medicaid enrollment, and TCHP requires Medicaid enrollment. A pediatric practice can often use the exemption.

More Texas plan guides: Community Health Choice · Molina · Wellpoint Texas · Driscoll Health Plan · El Paso Health · 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. Texas Children's Health Plan, Becoming a Participating Provider (Cobblestone Gateway, user guide, Verisys, status emails, in-service). texaschildrenshealthplan.org
2. Texas Children's Health Plan, provider alert: New Contracting Platform, Cobblestone Gateway, November 2, 2023. texaschildrenshealthplan.org
3. Texas Children's Health Plan, Provider Quick Reference Contact Guide, 2024. texaschildrenshealthplan.org
4. Texas Children's Health Plan, Provider Information Form (credentialing rights, corrections within 10 days). texaschildrenshealthplan.org
5. Texas Children's Health Plan, STAR Kids Provider Manual, 2024 (Northeast service area counties). texaschildrenshealthplan.org
6. Texas Children's Health Plan, FY26 STAR/CHIP Provider Manual (claims filing, corrected claims, appeals). texaschildrenshealthplan.org
7. Texas Children's Health Plan, Behavioral Health Level of Care Guideline, version 8, March 2025. texaschildrenshealthplan.org
8. Texas Children's Health Plan, Prior Authorization Requirements, April 2025. texaschildrenshealthplan.org
9. Texas Children's Health Plan, Prior Authorization Information (behavioral health fax). texaschildrenshealthplan.org
10. Texas Children's Health Plan, In-Lieu-Of Services provider alert, April 2025. texaschildrenshealthplan.org
11. Texas Children's Health Plan, "Postponed: Updated PEMS Portion to Allow Provider Credentialing." texaschildrenshealthplan.org
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 comparison charts by service area (MRSA Northeast). 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
19. Blue Cross and Blue Shield of Texas Medicaid, "Reminder: Medicare Requires LPC and LMFT Enrollment," May 14, 2024. bcbstx.com
20. Fierce Healthcare, "Texas pauses $116B Medicaid contract awards; state health plans relieved." fiercehealthcare.com
21. Texas Tribune, "State rejects health insurers' pleas to halt plan that will shake up coverage for 1.8 million Texans," June 6, 2024. texastribune.org

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