How to get credentialed with Texas Medicaid: TMHP, PEMS and the managed care plans

At a glance

Who Texas Medicaid pays for behavioral health

Before you spend a month on applications, confirm that Texas Medicaid pays your license or program type for the services you plan to bill. The authority is the Behavioral Health chapter of the TMPPM on TMHP's website, which lists the provider types, codes, limits and prior-authorization rules.

Mental-health-only programs fall under different rules from SUD programs. If you plan a mental health IOP or PHP, check how Texas Medicaid and each MCO cover that level of care for your provider type before you count on the revenue.

Before you start

On the Texas roadmaps we run, TMHP enrollment waits for the NPIs, the office, the credentialing packet and, for a program, the HHSC license application; we budget about 45 days for it. The managed care applications wait for TMHP and a finished CAQH profile, and we budget about 90 days for those. Have this ready first:

• NPIs: your individual NPI (Type 1) and, for a group or program, the organization NPI (Type 2), with taxonomies that match what you'll bill.
• Your Texas license (or the program's HHSC facility license), current and in the exact legal name you'll use everywhere.
• The IRS letter with your EIN and a signed W-9, matching the legal name to the letter.
• Ownership and management details: everyone with 5% or more ownership, and managing employees, with dates of birth and Social Security numbers. Medicaid screens every one of them against the federal and Texas exclusion lists.
• Medicare enrollment if you're an LPC or LMFT (or a Medicare-eligible provider type serving people with both). Texas rule 1 TAC 352.13 requires providers who serve people with both to enroll in Medicare before Medicaid.
• A CAQH profile, complete and attested. Most Texas Medicaid MCOs read it.

Step 1: Enroll with Texas Medicaid through TMHP

1. Create your PEMS account on tmhp.com and start the right application type: individual, group (with performing providers) or facility.
2. Answer the program-specific questions. For LPCs and LMFTs, this is where you enter your Medicare number or claim the pediatric practice exemption. If you answer "no" to the Medicare question, you'll submit a Medicare Waiver Request, which is reviewed before approval (Community Health Choice notice, 2024).
3. Upload your documents: license, IRS letter, ownership disclosures and anything else PEMS asks for. Some providers are asked for fingerprints or more screening based on their risk category.
4. Pay the application fee if you're an institutional provider: $750 in 2026, set each year by CMS (CMS enrollment fact sheet). If you already paid it to Medicare or another state's Medicaid or CHIP program, send proof instead (Texas notice on the fee).
5. Respond to deficiency letters fast. Most delays are a missing page or a name mismatch.
6. Get your approval and your Texas Provider Identifier. Enrollment lets you bill traditional (fee-for-service) Medicaid. It doesn't put you in any MCO's network.

Enrolling with TMHP is necessary but not enough. Most Texas Medicaid clients get their care through managed care plans, and each one is a separate contract.

Step 2: Credential with each managed care plan in your area

Texas Medicaid and CHIP are delivered mostly through managed care programs:

• STAR: most children, pregnant women and some families.
• STAR+PLUS: adults with disabilities and adults 65 and older.
• STAR Kids: children and young adults with disabilities.
• STAR Health: children in foster care, through one statewide plan (Superior HealthPlan).
• CHIP: children in families that earn too much for Medicaid but can't afford private coverage.

HHSC contracts plans by service area, so the plans you need depend on the counties you serve. These are the plans that serve Texas Medicaid and CHIP members today; check HHSC's current list for your service area before you apply, since line-ups change with HHSC's contracts.

For each plan: apply on its provider site (most read your CAQH profile), wait for verification and the plan's credentialing committee, then review and sign the contract. Programs apply for a facility contract instead. Some plans hand behavioral health to another company, like UnitedHealthcare's use of Optum; our sister site explains behavioral health carve-outs.

Start with the two or three plans that cover most of the Medicaid members in your counties, not all of them at once. Ask each plan whether its behavioral health panel is open in your area before you apply.

The single credentialing verification

Texas Medicaid MCOs don't each check your documents separately. Since April 1, 2018, they've used one centralized, NCQA-certified credentialing verification organization (the Texas CVO), managed by the Texas Association of Health Plans for all Medicaid MCOs, whether or not a plan is a TAHP member (TAHP's Credentialing 101). The plans' contract with HHSC requires it. The vendor doing the primary-source verification has been Aperture, now Verisys.

What that means for you: the license, education, sanctions and history checks happen once and are shared, which cuts duplicate requests. It doesn't replace each plan's own application, committee decision and contract, and you'll still be recredentialed on a regular cycle. Keep your CAQH profile attested so the CVO has current documents to verify.

Step 3: After you're in network

• Get each plan's effective date in writing and your provider ID with that plan. Load them into your EHR before the first claim.
• Check eligibility every visit. Texas Medicaid members can change plans; the plan on last month's card may not be this month's.
• Learn each plan's prior authorization rules for your services and levels of care. Our prior authorization guide covers the reviews.
• For clients with Medicare too, bill Medicare first; Texas Medicaid denies LPC and LMFT claims without a Medicare number on file.
• Keep rosters current. When a clinician joins or leaves, update PEMS and every plan. This is part of our credentialing upkeep, along with revalidation dates.

Revalidation every five years

Federal law requires Medicaid providers to revalidate their enrollment at least every five years, and some providers more often based on risk (HHSC's Medicaid provider enrollment page). In Texas it happens in PEMS:

• Your due date shows in PEMS. HHSC says to submit at least 120 days before it; health plans note you can start up to 180 days before.
• Providers with an email on file get reminders at 120, 90 and 45 days (Texas Children's Health Plan revalidation FAQ).
• Revalidation is done only when the status reads "Closed – Enrolled."
• Miss it and you're disenrolled from Texas state health care programs; claims and prior authorization requests after the deadline deny, and you start over with a new application.

For substance use programs

A Texas SUD IOP or PHP enrolls as a chemical dependency treatment facility after HHSC issues its license, then applies for facility contracts with the MCOs in its service area. Plan on the license first, then TMHP, then the plans; none of the plans will contract with a program that isn't licensed and enrolled. Confirm which program services each MCO pays for and how (daily rate or per service) during contracting, and budget for the months between opening and the first Medicaid payment. Each MCO application from a program is a facility contract: the organization application, the license, insurance certificates, policies and often a site visit. Ask each plan whether it also credentials your clinicians individually. The IOP / PHP Program Launch carries all of this on one roadmap, and our guide to starting an IOP or PHP in Texas puts this in order with the license and accreditation.

Getting help

Our credentialing service files the PEMS application, the Medicare step if you need it, and each managed care application, follows up every two weeks, and confirms each effective date in writing. Medicaid enrollment is $350 per clinician, which covers TMHP and your first managed care plan; each additional plan is $175 per plan for a clinician or $450 per plan for a program's facility contract. An LPC or LMFT who needs Medicare first adds Medicare enrollment at $350 per clinician.

For example, an LPC who wants Medicare, TMHP and three Medicaid plans, with CAQH built: $1,300 in all.

Questions

More credentialing guides: Medicare for LPCs and LMFTs · TRICARE for Texas providers · Credentialing services and prices · Start an IOP or PHP in Texas

Sources

Checked October 24, 2026.

1. Texas HHSC, "Medicaid Provider Enrollment" (revalidation every five years, PEMS, 120 days). hhs.texas.gov
2. 1 TAC 352.13 (Medicare enrollment before Medicaid enrollment). law.cornell.edu
3. TMHP, Texas Medicaid & Healthcare Partnership (PEMS and the Texas Medicaid Provider Procedures Manual). tmhp.com
4. TMHP, "Substance Use Disorder Benefits to Change for Texas Medicaid January 1, 2019" (SUD treatment in licensed chemical dependency treatment facilities), November 16, 2018. tmhp.com
5. Texas Association of Health Plans, "Credentialing 101," Fall 2024 (the Texas CVO). tahp.org
6. Superior HealthPlan, CVO provider presentation (centralized CVO effective April 1, 2018). superiorhealthplan.com
7. Blue Cross and Blue Shield of Texas (Medicaid), "Reminder: Medicare requires LPC, LMFT enroll," May 14, 2024. bcbstx.com
8. El Paso Health, "Reminder: LPC and LMFT Providers Must Enroll in Medicare Effective March 1, 2024." elpasohealth.com
9. Blue Cross and Blue Shield of Texas, PEMS revalidation one-pager. bcbstx.com
10. Texas Children's Health Plan, Revalidation FAQ, March 26, 2025 (PEMS reminders at 120, 90 and 45 days). texaschildrenshealthplan.org
11. Magellan Healthcare, "Texas providers: Complete Medicaid enrollment revalidation." magellanhealthcare.com
12. CMS, Medicare enrollment for providers (MLN9658742): the 2026 application fee. cms.gov
13. Texas Vendor Drug Program, "Provider Enrollment Application Fee Increased for 2024" (fee paid to TMHP; waived with proof of payment elsewhere). txvendordrug.com

This guide is general information. Cima Consulting isn't a law firm or an accounting firm. HHSC, TMHP and each health plan make their own decisions; we don't guarantee approvals, rates or dates. Plan names and service areas change with HHSC's contracts.