Texas STAR+PLUS MCO Provider Enrollment: A Step-by-Step Credentialing Guide

This is the mistake that surprises new Texas home care agency owners the most: having an active HCSSA license from HHSC does not give you the right to bill STAR+PLUS managed care clients. Not immediately. Not automatically.

Your HCSSA license establishes that you are authorized by the state to provide home care services. MCO credentialing establishes that a specific managed care organization has reviewed your agency and accepted you into their provider network. These are two completely different processes, run by different organizations, with different timelines.

In practice: a Texas home care agency can receive its HCSSA license, start serving clients, and still be waiting 90–120 days for its first MCO payment because the credentialing pipeline was started late or done wrong.

This guide walks through the full MCO credentialing process — what you need before you apply, how to set up your CAQH profile, how to file individual MCO applications, and what causes the delays that push agencies back a full quarter.

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Texas HHSC divides the state into eleven service areas for STAR+PLUS managed care. As of the September 2024 STAR+PLUS contract awards, the MCOs operating in each area are:

• Superior HealthPlan (Centene) — largest footprint; active in most service areas including Areas 3 (Dallas/Fort Worth), 6 (Houston/Harris County), 7 (Central Texas/Austin), and 8 (San Antonio/Bexar County)
• Molina Healthcare of Texas — active in multiple service areas
• Aetna Better Health of Texas — active in multiple service areas
• UnitedHealthcare Community Plan — active in multiple service areas
• Cigna-HealthSpring — active in selected service areas
• Community First Health Plans — primarily Service Area 8 (San Antonio/Bexar County)

The practical implication: a Harris County agency will typically need to credential with four to five MCOs. A Dallas County agency will have a different roster. An agency in a smaller rural service area may have fewer.

How to identify your MCO roster: Determine your agency's primary county, look up its HHSC service area assignment on the HHSC STAR+PLUS webpage, and check the current MCO list for that area. The roster is updated with each contract cycle — confirm current assignments before filing applications.

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File any MCO application before these are in order and you will either be rejected outright or spend weeks chasing corrections.

1. Active HCSSA license Your HHSC HCSSA license must be active — not pending, not expired. MCOs query the HHSC licensee database directly to verify status. An application filed during your licensure pending period will be returned.

2. NPI Type 2 (organizational) Your agency needs a Type 2 NPI registered to your legal entity. Do not use a Type 1 (individual provider) NPI for the agency enrollment. If you have not applied for an NPI yet, submit through NPPES (nppes.cms.hhs.gov) and allow 10–14 business days for issuance.

3. EIN and W-9 Your federal Employer Identification Number, matching the IRS records for your legal entity. Discrepancies between your W-9 EIN and your application entity name trigger credentialing committee holds.

4. Correct taxonomy code(s) For personal attendant services: 251E00000X (Home Health Aide). For skilled home health: 251G00000X (Visiting Nurse). Using the wrong taxonomy code causes delays because your application gets routed to a reviewer for a different service type. Confirm the right code with each MCO's provider enrollment team before submitting.

5. State Medicaid Provider ID (TMHP) Some MCOs require a Texas Medicaid provider number issued by the Texas Medicaid & Healthcare Partnership before they will process your application. Apply to TMHP early — the turnaround is 30–45 days and it runs in parallel with your MCO applications.

6. EVV enrollment initiated Even after you pass MCO credentialing, you cannot bill for personal attendant services without being enrolled with an HHSC-approved EVV vendor (Sandata or HHAeXchange). Start EVV enrollment the same week you file your first MCO application. The timelines run in parallel and EVV approval can take 30–60 days.

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CAQH ProView is the centralized credentialing database used by most STAR+PLUS MCOs to verify provider information. It is not optional — most Texas MCOs reference CAQH as part of their primary source verification. A complete, current CAQH profile is the foundation every MCO application builds on.

Required for your CAQH organization profile:

• Agency legal name and DBA name
• NPI (Type 2) and EIN
• Primary practice address and all service delivery addresses
• HCSSA license number, issue date, expiration date
• Taxonomy code(s) for services provided
• All Medicaid program participations (STAR+PLUS, STAR Kids, fee-for-service, etc.)
• W-9 documentation
• General liability and professional liability insurance certificates with policy limits and dates
• SAM.gov and OIG exclusion list verification for the agency and its authorized agents
• Authorized representative name, title, and contact information

The most critical CAQH requirement: re-attest every 120 days.

CAQH profiles expire and require re-attestation every 120 days. An MCO pulling your CAQH data will see your last attestation date. If your profile is more than 120 days since attestation, your application will stall while the MCO waits for a current profile.

Set a recurring 90-day calendar reminder for CAQH re-attestation before you file your first application. Assign one person to own the CAQH account permanently — this is not a one-time setup task.

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Each STAR+PLUS MCO runs its own credentialing process. There is no universal STAR+PLUS application. You must apply to each MCO separately, through their own portal, with their own required documents.

Standard documents required by all MCOs:

• Completed provider application (MCO-specific form)
• NPI Type 2 confirmation
• EIN / W-9
• Copy of active HCSSA license
• CAQH ProView organization ID
• Taxonomy code(s)
• Liability insurance certificate(s)
• Articles of incorporation or business registration documents
• Authorized signatory information (must match what's on file with the state)
• List of all practice locations to be enrolled

How to locate MCO provider enrollment portals: Each MCO maintains a Texas Medicaid or STAR+PLUS section on its provider website. Search for "[MCO name] Texas STAR+PLUS provider enrollment" to find the correct application and contact. These URLs change — do not rely on a link from a year-old source. Locate the current portal on each MCO's website before you file.

Application submission protocol:

1. Submit the application and record: submission date, method (online portal vs. fax vs. mail), the application reference number provided, and the name of the provider enrollment representative you spoke with.
2. Send a written follow-up confirming receipt within 3 business days of submission.
3. Calendar a 30-day follow-up call to confirm your application is in process and has not been returned for missing information.

Applications get lost. This is common enough that following up proactively at 30 days is standard practice, not optional.

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Once your application is complete, the MCO's credentialing committee verifies your agency against primary sources. This is where applications fail for reasons you cannot fix after the fact.

What credentialing committees verify:

• HCSSA license status and good standing (HHSC direct query)
• NPI and NPPES record accuracy
• OIG/LEIE exclusion list (for the agency and its officers/owners in some MCOs)
• SAM.gov exclusion list
• State Medicaid exclusion lists
• Liability insurance currency and coverage limits
• Discrepancy review: any mismatch between your application data and primary sources

What causes committee holds:

If a committee review identifies a deficiency, the MCO will notify you in writing. You typically have 15–30 days to submit corrected documentation. Missing that window causes the application to close — you restart from the beginning.

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Passing credentialing review does not make you a contracted provider. After approval, the MCO issues a Provider Services Agreement (PSA) for you to execute. Only after the signed PSA is countersigned by the MCO are you contracted and authorized to submit claims.

Critical: The person who signs the PSA must be the authorized representative named in your application, whose authority is documented in your articles of incorporation or a board resolution. A signature from an unauthorized party causes the contract to be returned — and restarts your timeline.

Once contracting is complete, each MCO will assign you a provider network ID or Medicaid provider number for billing purposes.

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Plan your cash flow around this table before you start serving STAR+PLUS clients.

The cash flow implication: An agency that begins serving STAR+PLUS clients before credentialing is complete will carry those clients unbilled for 90–150 days. Build bridge financing or limit STAR+PLUS client intake until you have at least two MCOs contracted.

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STAR Kids is a separate managed care program serving children and young adults with complex medical needs. Even if you are credentialed as a STAR+PLUS provider, you must apply separately to STAR Kids networks. The MCO roster is different.

STAR Kids MCOs (as of 2024): Driscoll Health Plan, Superior HealthPlan, Molina Healthcare of Texas, UnitedHealthcare Community Plan, and Texas Children's Health Plan.

If your agency will serve clients in both programs, run both MCO application tracks simultaneously rather than sequentially. Starting STAR Kids applications after STAR+PLUS credentialing completes adds another 90+ days before you can bill STAR Kids clients.

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MCO credentialing is not a one-time event. Every contracted MCO relationship requires ongoing maintenance.

Standard ongoing requirements:

• CAQH re-attestation: Every 120 days. Build this into your operations calendar permanently.
• MCO re-credentialing cycles: Most STAR+PLUS MCOs require full re-credentialing every 2–3 years. Mark the re-credentialing due dates in your compliance calendar at initial contracting.
• Material change reporting: Changes to practice locations, service areas, taxonomy codes, ownership, or legal entity structure must be reported to each MCO within 30 days in most contracts. Unreported changes can trigger mid-cycle audit reviews.
• License and insurance renewal notifications: When your HCSSA license or liability insurance renews, proactively submit updated documents to each MCO — do not wait for them to ask.

A lapse in re-credentialing causes temporary removal from the MCO provider network. During the gap, you cannot submit claims for that MCO's members. This is one of the most common sources of unexpected revenue interruptions for established Texas home care agencies.

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These are the eight issues that most often push agency credentialing past 120 days.

1. CAQH profile not set up before applications are filed. MCOs will not process your application while CAQH is pending. Set up CAQH first.
2. CAQH re-attestation overdue at time of application. Re-attest before you file. Set a reminder 2 weeks before any application submission.
3. Name discrepancy across documents. The legal entity name must be character-for-character identical on your HCSSA license, NPI record, W-9, articles of incorporation, and application.
4. Wrong taxonomy code. Confirm with each MCO's provider enrollment team before submitting.
5. No 30-day follow-up call. Applications get lost. Call at Day 30 to confirm receipt and processing status.
6. Authorized signatory mismatch on PSA. Document authorized signatory authority before contracting begins.
7. OIG or SAM exclusion. Check owners and officers before filing, not after a committee hold.
8. EVV enrollment not started in parallel. Credentialing without EVV enrollment means you cannot bill when contracting finishes. Start both at the same time.

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Most Texas home care agencies start credentialing as an owner-driven task and eventually hit capacity. The work compounds: initial applications across 4–5 MCOs, followed by parallel re-credentialing cycles, material change notifications, CAQH re-attestation every 120 days, insurance certificate renewals, and STAR Kids applications when you expand.

The agencies that manage this well treat credentialing as a scheduled, documented, calendar-driven function — not a reactive one. That means a credentialing tracker (spreadsheet or dedicated tool), a compliance calendar with all renewal and re-credentialing dates mapped out, and one person who owns it.

If you are managing credentialing yourself or delegating it to a scheduling-focused office manager, the Atlas Care credentialing team handles the full lifecycle for Texas agencies: initial MCO application coordination, 30-day follow-up calls, deficiency responses, PSA execution tracking, CAQH re-attestation reminders, and re-credentialing cycles.

See what's included in Atlas Care's credentialing support →