Credentialing Services in Texas

In Texas, one missed date can undo years of credentialing work: a provider who misses Medicaid revalidation is dropped from every program at once, including every managed care and dental plan network. Getting in is just as exacting, with name-matching rules, deficiency deadlines, and Medicare requirements for many behavioral health clinicians. Maximum Billing provides credentialing services for Texas practices, handling Texas Medicaid enrollment through TMHP, STAR plan contracts, commercial plans, Medicare, and CAQH.

Schedule a consultation or call 800-820-0364.

Client results as of 2026. Request a billing review.

Credentialing Services for Texas Practices

• PEMS enrollment with Texas Medicaid, as an individual, a performing provider under a group, or a group.
• Ownership and control disclosures completed correctly the first time.
• Managed care contracts with the STAR, STAR+PLUS, STAR Kids, STAR Health, and CHIP plans in your service area.
• Medicare enrollment through PECOS, which many Texas behavioral health clinicians need first.
• Commercial plan credentialing and CAQH ProView upkeep.
• Deficiency responses inside TMHP’s deadlines.
• Revalidation tracking, using the early filing window so nothing reaches the grace period.

Texas Medicaid Enrollment Through TMHP

The Health and Human Services Commission (HHSC) oversees Texas Medicaid, and the Texas Medicaid & Healthcare Partnership (TMHP) processes enrollment in PEMS under Section 1 of the Texas Medicaid Provider Procedures Manual. A few rules decide whether an application moves:

• For a corporation, the name on the W-9 has to match the Franchise Tax Account Status page and the Certificate of Formation exactly.
• The Texas license cannot be within 30 days of expiring.
• Deficiencies have to be fixed within 30 business days, and no application can stay open past 165 cumulative business days.

Our Texas Medicaid provider enrollment guide walks through PEMS step by step.

STAR Plans and Dental Maintenance Organizations

The provider manual is explicit that Texas Medicaid enrollment must be approved before any managed care enrollment, and then each health plan is a separate application. The plans available depend on your service area; HHSC’s list includes Aetna, Blue Cross and Blue Shield, Community First, Community Health Choice, Cook Children’s, Dell Children’s, Driscoll, El Paso Health, Molina, Parkland, Superior, Texas Children’s, UnitedHealthcare, and Wellpoint. Children’s dental services go through the dental maintenance organizations DentaQuest, MCNA Dental, and UnitedHealthcare Dental, so dentists contract with the DMOs after state enrollment. See our dental credentialing services and Texas dental billing services.

Behavioral Health Credentialing in Texas

The current Behavioral Health Handbook in the provider manual requires LCSWs, LPCs, LMFTs, and psychologists to be enrolled in Medicare or to qualify for a pediatric practice exemption, and temporary licenses are not accepted for LCSWs, LPCs, or LMFTs. That makes Medicare enrollment the first step for many Texas therapists. Older editions of the manual described this differently, so we check the current handbook for each license. See our mental and behavioral health credentialing services and Texas mental health billing services.

Revalidation Without the Risk

Most Texas providers have a five-year enrollment period, and some are shorter based on risk. Revalidation can be filed up to 180 days early, with a 45-day grace period after the due date. Because a missed revalidation disenrolls a provider from every program, we file early rather than counting on the grace period.

Timelines

The provider manual says enrollment typically takes up to 60 days once the application is complete. Plan credentialing follows, so practices should allow several months before a new clinician sees STAR plan members.

Frequently Asked Questions

Do Texas therapists need Medicare to enroll in Texas Medicaid?

Under the current Behavioral Health Handbook, LCSWs, LPCs, LMFTs, and psychologists must be enrolled in Medicare or qualify for a pediatric practice exemption.

What happens if a Texas provider misses Medicaid revalidation?

The provider is disenrolled from all programs, including managed care and dental plan networks.

How long do I have to fix a TMHP deficiency?

Thirty business days, or the application is terminated.

Which dental plans serve Texas Medicaid children?

The dental maintenance organizations DentaQuest, MCNA Dental, and UnitedHealthcare Dental.

Credentialing for Texas Practices

Tell us about your clinicians, service area, and the plans you want to join, and we will map out the applications. We also provide Texas medical billing once contracts are active. See our credentialing and payer enrollment services, or contact us to get started.