As we look ahead to 2026, the world of mental health insurance credentialing continues to shift, bringing both opportunities and challenges for providers. From state-level program overhauls to ongoing federal initiatives, staying informed is key to ensuring your practice thrives and your clients receive the care they need.

Here’s a look at some of the significant developments and trends shaping mental health credentialing for the coming year:

Ohio’s MyCare Program Overhaul: A Precedent for Change?

One of the most impactful recent announcements, affecting many providers, especially those serving dual-eligible clients, comes from Ohio. Effective January 1, 2026, Aetna Better Health of Ohio and UnitedHealthcare Community Plan will no longer be part of the MyCare Ohio program. The Ohio Department of Medicaid (ODM) has awarded contracts to only Anthem Blue Cross and Blue Shield, Buckeye Health Plan, CareSource, and Molina Healthcare of Ohio for its “Next Generation MyCare Program.”

What does this mean?

• For Ohio Providers: If you currently contract with Aetna or UnitedHealthcare for MyCare Ohio members, you must now credential and contract with one of the four selected plans to continue serving these clients. This is a significant administrative undertaking that requires proactive engagement now to avoid service disruptions.
• For Ohio Members: Those enrolled with Aetna or UnitedHealthcare for MyCare will need to select a new plan.
• Broader Implications: This move by Ohio’s ODM could signal a trend. Other states may follow suit, re-evaluating their managed care contracts to streamline programs or enhance specific service delivery goals. This emphasizes the importance of diversified credentialing and staying updated on state-specific Medicaid and dual-eligible program changes.

The Push for Streamlined Federal Credentialing

While not always immediate, the push for more efficient federal credentialing continues to be a hot topic. The goal? To reduce administrative burden and get providers into networks faster, ultimately increasing access to care.

• PECOS Enhancements: Expect ongoing enhancements to the Provider Enrollment, Chain and Ownership System (PECOS) by CMS. The aim is to make the Medicare and Medicaid enrollment process more intuitive and reduce processing times. While these changes are iterative, they collectively contribute to a smoother experience over time.
• Standardization Initiatives: Discussions around standardizing credentialing requirements across federal programs, and potentially encouraging commercial payers to adopt similar models, are always in the background. While a complete overhaul is complex, any moves toward greater standardization are welcome news for mental health providers, who often juggle diverse payer requirements.

Telehealth Credentialing: Permanent Fixtures and Evolving Rules

The post-pandemic landscape has solidified telehealth’s role in mental healthcare, but the rules for credentialing are still evolving.

• Permanent Flexibilities: Many of the telehealth flexibilities for mental health services that emerged during the Public Health Emergency (PHE) have been made permanent or extended, particularly by CMS. This provides stability for providers offering remote care.
• Commercial Payer Alignment: For 2026, the focus will be on continued alignment from commercial payers. While most have embraced telehealth, providers must meticulously verify each payer’s specific requirements regarding:
  • Place of Service (POS) codes (e.g., POS 02 for telehealth, POS 10 for telehealth in the home).
  • Modifiers (e.g., -95).
  • State-specific regulations for interstate practice.
  • Supervision requirements for associate-level therapists practicing via telehealth.
• Digital Health Credentialing: The rise of digital mental health platforms and apps is creating new credentialing pathways. Expect more specific guidelines for providers working exclusively or primarily through these digital modalities, focusing on security, privacy, and quality assurance.

The Ongoing Battle Against Administrative Burden

The administrative burden of credentialing remains a significant challenge, especially for solo practitioners and small group practices.

• CAQH ProView is Still King: CAQH ProView remains the central hub for most commercial and some state Medicaid plans. Maintaining an accurate, up-to-date, and frequently attested CAQH profile (at least every 90-120 days) is non-negotiable for streamlining the recredentialing process.
• Credentialing Services: The trend of outsourcing credentialing to specialized services is likely to continue growing in 2026, as practices seek to offload this complex, time-consuming task to focus on client care.
• AI and Automation: While still in early stages, the integration of AI and automation into credentialing processes (for things like document verification, data extraction, and status tracking) will see continued development, promising long-term relief from manual tasks.

Looking Ahead

For mental health professionals, 2026 promises to be a year of adaptation and strategic planning in the credentialing arena. Changes like Ohio’s MyCare program highlight the need for vigilance regarding state-level reforms. Simultaneously, ongoing federal efforts and the evolving telehealth landscape underscore the importance of meticulous documentation and proactive engagement with payers.

The core message for 2026 is clear: stay informed, stay organized, and don’t underestimate the power of proactive credentialing management. Your ability to navigate these changes directly impacts your practice’s stability and your clients’ access to vital mental health services. Let MedTrust Provider Advocates be your compass to help you navigate these changes.

As the holidays approach, hospitals and clinics across the country fill with the spirit of giving, gratitude, and togetherness. While the holiday season is a time for celebration and reflection, it’s also a unique moment to recognize the unsung heroes of healthcare—credentialing professionals—whose diligent work ensures every provider is ready to deliver safe, high-quality care. This year let’s unwrap the ways healthcare credentialing embodies the true meaning of the season and brings joy to both staff and patients.

The Spirit of Giving and Service

The holiday season is rooted in traditions of generosity, compassion, and community. Credentialing teams like MedTrust Provider Advocates quietly serve by verifying qualifications, protecting patient safety, and supporting providers behind the scenes. Their commitment reflects the same spirit of giving that defines the holiday—ensuring every patient receives care from trusted, competent professionals.

Credentialing professionals, much like the figures of Christmas lore, work tirelessly to deliver peace of mind as their “gift” to hospitals, mental health providers, and patients. Their efforts make it possible for others to focus on healing and hope during a season that can be especially challenging for those in need.

Building Connections and Community

The holidays are about cherishing connections and expressing gratitude for those who make a difference in our lives. In the healthcare community, the holiday are a time when teams come together to celebrate successes, reflect on challenges, and show appreciation for each other’s dedication. Credentialing teams play a vital role in this collaborative environment, helping to build a foundation of trust and reliability that supports every department.

Many healthcare organizations find creative ways to spread cheer during the season, from decorating workspaces and organizing potlucks to participating in charitable drives that benefit patients and local families. These traditions foster a sense of unity and remind everyone of the shared mission to care for others.

Small Acts, Big Impact

Just as a simple gift can brighten someone’s day, small acts by credentialing professionals—like expediting a provider’s approval or resolving a last-minute issue—can have a profound impact on patient care and provider satisfaction. Their attention to detail and dedication ensure that the right people are in the right place, at the right time, especially during the busy holiday season.

Stories from hospitals highlight how the holiday spirit extends beyond patient care to the entire healthcare team. From “Santa” visits in the NICU to festive activities for staff and families, these moments of joy and gratitude are made possible by the seamless work of credentialing and support staff behind the scenes.

Reflecting on the Year and Looking Ahead

The holiday season is also a time to look back on the year, celebrate achievements, and prepare for the challenges ahead. Credentialing teams can take pride in their essential contributions, knowing that their work upholds the highest standards of care and safety. As we gather with loved ones or colleagues—whether in person or virtually—let’s remember to thank those who make healthcare possible, especially during the holidays.

MedTrust Provider Advocates wishes you a joyful holiday season filled with gratitude, connection, and the quiet gifts of service that make all the difference in healthcare.

Gratitude at the Heart of Quality Care

As Thanksgiving approaches, many of us pause to reflect on what we’re grateful for—family, friends, good food, and good health. In the world of healthcare, there’s another group that deserves our appreciation: the credentialing professionals who work tirelessly behind the scenes to ensure that every provider is qualified, compliant, and ready to deliver safe patient care.

This Thanksgiving, let’s take a moment to recognize the unsung heroes of healthcare credentialing and explore why their work is something we can all be thankful for.

The Unsung Heroes at the Credentialing Table

While most people think of doctors, nurses, and other providers when they picture healthcare, few realize the critical role credentialing teams play. Like the chefs preparing a Thanksgiving feast, credentialing specialists ensure that every ingredient—every provider’s education, training, licensure, and background—is thoroughly checked and verified before anyone takes a seat at the table.

The Recipe for Quality Care

Credentialing is the secret recipe that keeps healthcare organizations running smoothly. Just as a Thanksgiving meal requires careful planning and attention to detail, so does the credentialing process. Each step—application, verification, committee review, and approval—ensures that only the most qualified professionals are granted privileges to care for patients.

Without this process, the quality and safety of patient care could be at risk. That’s a recipe for disaster! So, let’s give thanks for the diligence and dedication of credentialing professionals who keep our healthcare system safe and strong.

Gratitude for Teamwork

Thanksgiving is all about coming together, and credentialing is no different. It takes collaboration between providers, administrators, HR, and credentialing specialists to gather documents, verify information, and meet deadlines. When everyone works together, the result is a seamless onboarding process and a strong, unified healthcare team.

Counting Our Blessings: The Benefits of Effective Credentialing

• Patient Safety: Proper credentialing protects patients by ensuring only qualified professionals provide care.
• Compliance: Staying up-to-date with regulatory requirements helps organizations avoid costly penalties.
• Provider Satisfaction: A smooth credentialing process helps new providers feel welcomed and supported.
• Organizational Reputation: Effective credentialing builds trust with patients, payers, and the community.

Sharing the Gratitude

This Thanksgiving, consider showing your appreciation to the credentialing team with a heartfelt thank-you note, a shout-out at your next staff meeting, or even a slice of pumpkin pie. Their work may be behind the scenes, but its impact is felt by everyone.

Final Thoughts: A Table Set for Success

As we gather around the Thanksgiving table, let’s remember the importance of healthcare credentialing in delivering safe, high-quality care. By giving thanks for the professionals who make it all possible, we celebrate the spirit of teamwork, diligence, and gratitude that defines both Thanksgiving and the healthcare community.

From the MedTrust credentialing family to yours, have a safe, happy, and healthy Thanksgiving!

Aetna Better Health of Ohio and UnitedHealthcare Community Plan are being removed from the MyCare Ohio program.

This change is happening as the Ohio Department of Medicaid (ODM) transitions to the “Next Generation MyCare Program.”

Here are the key details you need to know:

Effective Date of Change

• Both Aetna Better Health of Ohio and UnitedHealthcare Community Plan will no longer be MyCare Ohio plans effective January 1, 2026.

The Reason for the Change

• The Ohio Department of Medicaid (ODM) is reforming the dual-eligible program by launching the Next Generation MyCare Program beginning January 1, 2026.
• In November 2024, ODM announced the four managed care organizations (MCOs) that were awarded contracts to serve as the Next Generation MyCare plans:
  1. Anthem Blue Cross and Blue Shield
  2. Buckeye Health Plan (Currently in MyCare and will continue)
  3. CareSource (Currently in MyCare and will continue)
  4. Molina HealthCare of Ohio (Currently in MyCare and will continue)
• Aetna and UnitedHealthcare were not among the MCOs selected for this next generation of the program.

Impact on Providers

• Continuation of Claims Payment: Aetna and UnitedHealthcare are responsible for paying claims for services rendered through December 31, 2025. They will continue to process and pay claims for up to 365 days from the end of the year.
• New Contracts Needed: Providers who wish to continue serving MyCare members must ensure they are contracted and credentialed with the remaining Next Generation MyCare plans (Anthem, Buckeye, CareSource, and Molina).

Impact on Members

• No Loss of Coverage: Current MyCare Ohio members will not lose coverage due to this change.
• Action Required: Members currently enrolled with Aetna Better Health of Ohio or UnitedHealthcare Community Plan must select a new Next Generation MyCare plan for their coverage beginning January 1, 2026.
• Automatic Enrollment: If a member does not select a new plan during the open enrollment period (which is generally November 1–30), they will be automatically enrolled in one of the new Next Generation MyCare plans.

In summary, the removal of Aetna and UnitedHealthcare is part of Ohio’s statewide overhaul of its dual-eligible (Medicare/Medicaid) managed care program.

Navigating Delays and Challenges in Healthcare Administration

Government shutdowns are more than just headlines and political debates—they ripple through many aspects of American life, including the healthcare system. One vital area affected is insurance credentialing, a process crucial for providers seeking to participate in health plans and deliver care to patients. In this blog, we’ll explore how a government shutdown can disrupt insurance credentialing and what providers and administrators can do to prepare and respond.

How Government Shutdowns Affect Credentialing

During a government shutdown, non-essential federal agencies and staff may be furloughed or otherwise unable to perform their regular duties. Many components of insurance credentialing rely on government agencies, including:

• Medicare and Medicaid Enrollment: The Centers for Medicare & Medicaid Services (CMS) may experience staffing shortages or complete pauses in application processing, leading to delays for providers seeking to enroll or renew their credentials. CMS typically furloughs a portion of its staff during a shutdown. While Medicare and Medicaid claims payments are generally maintained because they are mandatory programs, administrative functions like provider enrollment (credentialing) are considered non-essential and slow down or stop entirely.
• This directly affects the processing of the CMS-855 applications submitted through PECOS (Provider Enrollment, Chain and Ownership System). New providers applying for a Medicare or Medicaid number may face extensive, indefinite delays before they can start billing.
• Background Checks: Credentialing often requires background checks processed by federal agencies. A shutdown can halt or slow these checks, stalling applications.
• State Medical Licensing Boards: While most state boards remain operational, those that depend on federal systems or data may also experience delays.
• Verification of Social Security Numbers and Citizenship: Some credentialing steps require validation through the Social Security Administration or other federal entities, which may be unavailable or backlogged during a shutdown.

Consequences for Providers and Patients

The direct consequence of these delays is that healthcare providers might not be able to see patients with certain insurance plans until credentialing is complete. This can result in:

• Loss of income for providers awaiting approval
• Reduced access to care for patients, especially in underserved areas
• Administrative bottlenecks for healthcare organizations

Strategies to Mitigate the Impact

While providers can’t prevent a government shutdown, there are steps that practices and organizations can take to minimize disruptions:

1. Start Early: Submit credentialing applications as soon as possible, especially if a shutdown appears likely.
2. Stay Informed: Monitor government announcements and professional association updates to anticipate potential delays.
3. Communicate Proactively: Keep patients and staff informed about potential impacts on appointment availability or coverage.
4. Maintain Accurate Records: Ensure all documents and licenses are up-to-date to avoid avoidable delays once processing resumes.

Looking Forward

Government shutdowns are disruptive, but understanding their effects on processes like insurance credentialing can help healthcare providers and organizations plan ahead. By remaining proactive and adaptable, the healthcare community can navigate these challenges and continue to provide essential care, even when government operations are temporarily on hold.

When you think of Halloween, you probably imagine costumes, candy, and a few friendly scares. But if you work in healthcare credentialing, you know that the credentialing process can sometimes feel just as tricky—and occasionally just as spooky! As October rolls around and the air fills with tales of haunted houses and ghostly ghouls, let’s take a lighthearted look at the parallels between healthcare credentialing and everyone’s favorite fright-filled holiday.

The Haunted Maze of Paperwork

Just like a haunted corn maze, the credentialing process can be full of twists, turns, and dead ends. Missing documents, outdated licenses, or incomplete applications can send you running in circles. The trick? Stay organized, keep a checklist, and don’t let the paperwork poltergeists catch you off guard!

The Disguises of Data

On Halloween, everyone loves to dress up and pretend to be someone else. In credentialing, it’s your job to make sure every provider is exactly who they say they are—no masks allowed! Verifying credentials, licenses, and work history is like unmasking the trick-or-treaters at your door. Only those with the right credentials get the treats (or, in this case, the privilege to provide care).

The Treats: A Smooth Credentialing Process

When everything goes right, credentialing can be a real treat. Providers are onboarded quickly, compliance is maintained, and patient safety is ensured. It’s the equivalent of finding a full-size candy bar in your trick-or-treat bag—a sweet reward for everyone involved.

The Spooky Surprises

Every Halloween party has its jump scares, and credentialing is no different. Maybe it’s a last-minute document request, an unexpected red flag in a background check, or a looming accreditation deadline. These surprises can send chills down any administrator’s spine. The key is to be prepared and have a plan for those “boo!” moments.

How to Avoid Credentialing Nightmares

• Stay organized: Use digital credentialing tools to keep everything in one place.
• Communicate clearly: Let providers know exactly what’s needed and when.
• Double-check everything: Don’t let a missing signature turn into a credentialing ghost story.
• Celebrate your wins: When the process goes smoothly, treat yourself (and your team) to a little Halloween candy!

Final Thoughts: No Tricks, Just Treats

Healthcare credentialing doesn’t have to be scary. With MedTrust Provider Advocates by your side, along with the right tools, a proactive approach, and a sense of humor, you can turn even the spookiest credentialing challenges into opportunities for improvement—and maybe even a little fun. So this Halloween, as you hand out candy and enjoy the festivities, remember: in the world of credentialing, MedTrust keeps the monsters at bay and ensures everyone gets the treats they deserve.

What It Means for Patients and Providers

Exploring the Impact of Policy Changes on Telemedicine Access

Introduction

Telehealth has revolutionized the way healthcare is delivered in the United States, especially in recent years. With the surge in demand during the COVID-19 pandemic, Medicare’s temporary coverage of telehealth services provided essential access for millions of seniors and people with disabilities. However, recent changes have resulted in Medicare  no longer covering telehealth, leaving many to wonder about the future of virtual care.

The Rise and Fall of Telehealth Coverage

When the pandemic began, the Centers for Medicare & Medicaid Services (CMS) quickly expanded telehealth coverage, allowing beneficiaries to receive a wide range of medical services from the safety of their homes. This policy shift was hailed as a critical step toward modernizing healthcare and reducing barriers to care for vulnerable populations.

However, these flexibilities were always intended as a temporary measure. As the public health emergency has ended, Medicare has phased out its expanded telehealth coverage. This means that, except for certain limited cases, Medicare beneficiaries can no longer use their insurance for virtual visits with their doctors.

What Does the Policy Change Mean?

The rollback has significant implications for both patients and healthcare providers:

• Patients lose convenience and access: Many seniors and people with disabilities who benefited from remote consultations now face increased challenges in accessing care, particularly those in rural areas or with mobility issues.
• Healthcare providers adjust operations: Clinics and practices that invested in telehealth infrastructure must now reconsider their offerings and workflows, which could result in financial strain or reduced service availability.
• Potential for increased in-person visits: As patients return to traditional office visits, there may be longer wait times, more crowded waiting rooms, and heightened exposure to communicable illnesses.
• Practitioners who provide behavioral and mental health via telehealth must now provide in-person visits within six months of the first telehealth visit and annually thereafter.

Why Did Medicare End Telehealth Coverage?

The decision to end expanded telehealth coverage is rooted in concerns over cost, fraud prevention, and the desire to return to pre-pandemic regulatory standards. Policymakers have cited the need for careful evaluation of telehealth’s effectiveness and appropriate use before establishing permanent coverage. Although some advocates argue for lasting policy changes, Congress and CMS have yet to enact comprehensive legislation to make telehealth a permanent part of Medicare benefits.

How Are Patients and Providers Responding?

The response from the healthcare community and Medicare beneficiaries has been mixed:

• Patient advocacy groups are lobbying for the reinstatement of telehealth benefits, emphasizing the importance of access and flexibility for older adults and those with chronic conditions.
• Healthcare organizations are urging federal agencies and lawmakers to reconsider, pointing to data that shows telehealth can improve outcomes and reduce costs in certain settings.
• Some providers are exploring alternative payment models or offering telehealth as an out-of-pocket service, though this may not be feasible for all patients.

What’s Next for Telehealth and Medicare?

The future of telehealth under Medicare remains uncertain. While the current coverage has ended, ongoing discussions in Congress and among healthcare stakeholders could pave the way for more permanent solutions. For now, Medicare beneficiaries should check with their healthcare providers about the availability of telehealth services and any associated costs.

As the healthcare landscape continues to evolve, it’s clear that virtual care has become an integral part of how Americans access medical services. Policymakers, providers, and patients alike must work together to ensure that progress in healthcare delivery is not lost and that access remains a priority for all.

Conclusion

The end of Medicare’s telehealth coverage marks a significant shift in healthcare policy, with broad implications for access, convenience, and innovation. While the debate continues, one thing is clear: the conversation about telehealth is far from over, and its role in the future of healthcare will depend on the actions of policymakers and the voices of those it serves.

Additional information on this issue:

https://telehealthresourcecenter.org/resources/the-telehealth-policy-cliff-preparing-for-october-1-2025/

https://www.cms.gov/files/document/telehealth-faq-04-09-25.pdf

https://www.bakerdonelson.com/medicare-telehealth-waivers-extended-through-september-2025

Optum and UnitedHealthcare

Key Requirements for Joining the UnitedHealthcare (including Optum) Network in Texas:

• Use of CAQH ProView: UnitedHealthcare, including Optum networks, requires physicians and many other healthcare professionals in Texas to complete and maintain their information in the Council for Affordable Quality Healthcare (CAQH) ProView database. You will need to grant UnitedHealthcare access to your CAQH profile. Ensure all sections are complete and up to date.  
• Texas License: A current and unrestricted license to practice in Texas is mandatory. The license must be in good standing with the relevant Texas licensing board.
• Professional Liability Insurance: You will need to provide proof of current professional liability insurance that meets UnitedHealthcare’s minimum requirements for your specialty and the state of Texas. Specific limits may apply.
• Work History: Expect to provide a detailed work history for the past five years, with explanations for any gaps longer than six months.  
• Education and Training: Verification of your medical education, residency, fellowships, and other relevant training will be required.
• Board Certification: Information on your board certifications, if applicable to your specialty, will be necessary.
• Hospital Privileges: For physicians, information regarding current hospital privileges or admitting arrangements with participating hospitals may be required.
• DEA/CDS Certificate: If you prescribe controlled substances, you’ll need to provide your current DEA (Drug Enforcement Administration) and Texas CDS (Controlled Dangerous Substances) certificates.
• NPI (National Provider Identifier): You must have a valid NPI to participate in the network.
• Tax Identification Number (TIN): Your TIN is required for contracting and payment purposes.
• W-9 Form: You’ll likely need to submit a completed W-9 form.
• Practice Information: Details about your practice location(s), including addresses, phone numbers, and contact information.
• Attestation: You will need to attest to the accuracy of the information provided in your application.
• Background Check: A criminal background check is typically part of the credentialing process.
• Completion of UnitedHealthcare Application: While CAQH is a primary source of information, you will also need to complete UnitedHealthcare’s specific network participation request through their provider portal, Provider Express.

Steps to Credential with UnitedHealthcare (including Optum) in Texas:

1. Register with CAQH: If you are not already registered, go to the CAQH ProView website (www.caqh.org) and complete your profile. Ensure all information is accurate and up to date. https://proview.caqh.org/Login/Index?ReturnUrl=%2f
2. Access Provider Express: Go to the UnitedHealthcare Provider Portal (https://www.uhcprovider.com/) and register for or log in with your One Healthcare ID.  
3. Complete the Network Participation Request: Navigate to the “Join Our Network” or credentialing section and complete the online application. You will need to provide your demographic information, specialty, service locations, and other required details.
4. Authorize CAQH Access: Within the UnitedHealthcare application, you will need to authorize UnitedHealthcare to access your CAQH ProView profile.  
5. Submit Supporting Documentation: Upload any required supporting documents, such as copies of your Texas license, DEA/CDS certificates, liability insurance face sheet, board certifications, and W-9 form, through the Provider Express portal or as instructed.
6. Primary Source Verification: UnitedHealthcare will verify your credentials with the primary sources (licensing boards, educational institutions, etc.).
7. Credentialing Committee Review: Your application and verified information will be reviewed by UnitedHealthcare’s credentialing committee.  
8. Notification: You will be notified in writing of the committee’s decision regarding your participation in the network.
9. Contracting: If approved for credentialing, you will then proceed with the contracting phase to finalize your agreement with UnitedHealthcare.

Important Points:

• Provider Express: This is the primary online portal for UnitedHealthcare providers to manage their information, including the credentialing process.
• Timelines: The credentialing process can take time, typically 45 calendar days or more from when a complete application and all required information are received. Primary source verification timelines depend on the responsiveness of the verifying entities.
• Recredentialing: UnitedHealthcare requires recredentialing every three years. Maintaining an up-to-date CAQH profile and attesting to its accuracy every 90 days can streamline this process.
• Specific Requirements: Requirements can vary slightly based on your provider type (physician, allied health professional, facility, etc.) and specialty. Always refer to the official UnitedHealthcare provider website and relevant provider manuals for the most accurate and detailed information.
• Optum Specifics: If you are specifically joining an Optum network (e.g., Optum Behavioral Health, Optum Physical Health), the initial steps will likely still involve CAQH and the UnitedHealthcare Provider Portal. However, there might be specific application pathways or additional requirements depending on the Optum line of business. It’s best to clarify this during the initial application process.

Recommendation:

The most reliable way to understand the exact and current credentialing requirements for Optum/UnitedHealthcare in Texas is to:

1. Visit the UnitedHealthcare Provider Portal (https://www.uhcprovider.com/).  
2. Navigate to the “Join Our Network” or “Credentialing” sections.
3. Review the specific requirements and steps outlined for your provider type and specialty in Texas.
4. Contact United Healthcare Provider Services directly if you have specific questions.

By following these steps, you can ensure you have the most accurate and up-to-date information for a successful credentialing process with Optum and UnitedHealthcare in Texas as of May 7, 2025.

Summary Table: Optum Credentialing Steps in Texas

National Wellness Month

National Wellness Month is a month-long observance held every August that encourages individuals to prioritize self-care, build healthy routines, and focus on their overall mental, physical, and emotional well-being. It was founded in 2018 by Live Love Spa to promote the idea that wellness is a lifestyle, not just a luxury.

How it’s Celebrated

Throughout the month, people are encouraged to take a holistic approach to their well-being. This can involve making small, manageable changes that lead to healthier habits. Common ways to celebrate include:

• Physical Wellness: Engaging in regular physical activity, trying new exercises like yoga or hiking, staying hydrated, and focusing on a nutritious diet.
• Mental and Emotional Wellness: Practicing mindfulness or meditation, taking breaks from screens, spending time in nature, and setting aside time for hobbies or relaxation.
• Social Wellness: Reconnecting with friends and family, and building strong support networks.

The August Reset: Why National Wellness Month Matters

August is here, and with it comes a dedicated time to focus on what often gets pushed to the back burner: your wellness. This isn’t just a marketing gimmick; National Wellness Month is a nationwide movement to remind us that taking care of ourselves isn’t a luxury—it’s a necessity. In our fast-paced lives, prioritizing health can feel like a chore, but this month offers a perfect opportunity to pause, reset, and build sustainable habits for a healthier, happier you.

What is Wellness, Anyway?

Wellness is a lot more than just hitting the gym or eating a salad. It’s a holistic concept that encompasses our physical, mental, emotional, and social health. Think of it like a four-legged chair; if one leg is weak, the whole thing is wobbly.

• Physical Wellness: This is what we usually think of first. It includes things like getting regular exercise, eating nutritious food, drinking enough water, and getting adequate sleep.
• Mental Wellness: This is about actively managing stress, practicing mindfulness, and being kind to yourself. It’s about taking a break from the endless scroll and letting your mind rest.
• Emotional Wellness: This involves recognizing and accepting your feelings, both good and bad, and developing healthy coping mechanisms. It’s about building emotional resilience.
• Social Wellness: A strong support network is critical to our well-being. This includes connecting with friends, family, and your community.

Simple Ways to Celebrate This Month

You don’t need a complete life overhaul to get started. Small, consistent steps can lead to significant changes. Here are a few ideas to get you going:

• Hydrate, Hydrate, Hydrate: The simplest change with a huge impact. Carry a water bottle with you and set a goal to refill it throughout the day.
• Take a Walk: A quick 15-minute walk outside can boost your mood, improve cardiovascular health, and give you a much-needed break from your desk.
• Try a Digital Detox: Challenge yourself to put your phone away for an hour before bed or for a few hours on the weekend.
• Start a Gratitude Journal: Writing down three things you’re grateful for each day can shift your mindset and reduce stress.
• Reconnect: Schedule a coffee date or a phone call with a friend you haven’t talked to in a while.
• Prioritize Sleep: Create a wind-down routine that helps you relax. This could be reading a book, taking a warm bath, or listening to a calming podcast.

National Wellness Month is a great excuse to finally book that annual check-up, find a new healthy recipe, or simply give yourself permission to rest without guilt. It’s a reminder that your health is your most valuable asset. So, this August, take the “I Choose Wellness” pledge and make a promise to prioritize you.

Blue Cross Blue Shield of Texas (BCBSTX)

General Requirements:

• Provider Record ID: You’ll generally need a valid BCBSTX Provider Record ID for claim payment. This is usually obtained through an initial enrollment process.
• Signed Agreement: A current, signed BCBSTX contract or agreement is required.  
• CAQH Provider Data Portal (f.k.a ProView): BCBSTX mandates the use of the Council for Affordable Quality Healthcare (CAQH) ProView database for initial credentialing and recredentialing for physicians and professional providers. Complete the online application with “global” or “plan specific” authorization granted to BCBSTX. Failure to finalize your CAQH application within 45 days can lead to discontinuation of the process.
• Texas License: A valid, unrestricted license to practice in the state of Texas, in good standing with the relevant Texas Licensing Boards, is essential.
• Professional Liability Insurance: You’ll need current professional liability insurance coverage with minimum limits. For Texas providers, the minimum requirement has been $100,000 per occurrence and $300,000 in aggregate (this was updated from a previous $200,000/$600,000 requirement). Specific ancillary providers may have different liability coverage requirements (e.g., Home Health Agencies may require $500,000/$1,000,000).  
• Work History: Initial credentialing often requires a work history of the past five years with no gaps greater than six months, or explanations for any such gaps.
• Hospital Affiliations (MDs/DOs): Information on admitting arrangements and hospital privileges may be required. A Facility Coverage Letter might be accepted in lieu of privileges in some cases.
• DEA/CDS Certificate: If applicable to your practice, a current DEA (Drug Enforcement Administration) or CDS (Controlled Dangerous Substances) certificate for each state where services are provided may be necessary.  
• Board Certification: Information on board certifications, if applicable to your specialty.
• General Information: Basic personal details like name, date of birth, social security number (last four digits or NPI), and contact information are required.  
• Practice Location Information: Details of your primary practice location(s), including address, phone, fax, email, and Tax Identification Number (TIN).
• Attestation and Release: You’ll need to sign and date an attestation confirming the accuracy of the information provided and authorize BCBSTX to verify your credentials.

Specific Requirements for Different Provider Types:

• Physicians and Professional Providers: Primarily use CAQH ProView for initial credentialing and recredentialing. Those not listed in CAQH’s approved provider types may need to complete the Texas Standardized Credentialing Application from the Texas Department of Insurance (TDI) website.  
• Hospitals, Facilities, and Allied Providers: These entities also undergo a credentialing process. They need to complete the appropriate enrollment form based on their facility type and provide the required documentation. Facilities can often submit credentialing applications through Availity™. Recredentialing is typically required every three years.  
• Ancillary Providers: Have a specific credentialing and contracting process. They often need to first obtain a Provider Record ID by submitting an Ancillary Provider Record Request Form. Following this, they complete a Credentialing/Recredentialing Ancillary/Hospital Provider Questionnaire and submit it with required documentation (e.g., licenses, liability insurance, accreditation if applicable).
• Durable Medical Equipment (DME) Suppliers and other specialties: Have specific checklists outlining required licenses, insurance, and accreditations.

Key Steps in the Credentialing Process:

1. Obtain a Provider Record ID:

https://www.bcbstx.com/provider/network/network/provider-onboarding-process

1. Complete the CAQH Provider Data Portal application:

https://proview.caqh.org/Login/Index?ReturnUrl=%2f

1. Provide all required documentation, such as licenses, insurance certificates, and other supporting materials.
2. Authorize BCBSTX to access your CAQH data (if applicable).
3. Attest to the accuracy of your information and sign the required forms.
4. Submit the completed application and documentation to BCBSTX.
5. BCBSTX will review the application and verify your credentials through primary sources. This review can take approximately 8-10 calendar days once the CAQH application is complete.  
6. You may be required to undergo a site review (for facilities).
7. BCBSTX will notify you of the credentialing decision. Approval is required before you can participate in their networks.

Recredentialing:

• BCBSTX requires recredentialing of network providers every three years.
• Physicians and professional providers will use CAQH ProView for recredentialing, needing to review and attest to their data.  
• Hospitals, facilities, and allied providers use a specific Credentialing and Recredentialing Facility and Allied Provider Form.

Important Considerations:

• Timeliness: Completing the CAQH application within 14 days of submitting your enrollment form is often recommended. Failure to finalize it within 45 days can lead to discontinuation.  
• Accuracy: Ensure all information provided is accurate and complete to avoid delays. Incomplete or duplicate applications can result in delays.  
• Updates: You are responsible for informing BCBSTX of any changes to your practice information (demographics, etc.) in a timely manner, typically within 30-45 days of the change, often through the CAQH portal.  
• Provider Manuals: Refer to the BCBSTX Provider Manuals for detailed policies, procedures, and requirements. There are specific manuals for different networks (e.g., PPO, Medicaid STAR/CHIP).  
• Credentialing Status Checker: BCBSTX often provides an online tool to check the status of your credentialing process using your NPI or license number.

Summary Table: BCBS Credentialing Steps in Texas