State Law

Texas Statutes-Insurance Code-Subtitle F-Chapter 1457. Provisional Credentialing Status

08/24/2023 Texas Section 1457.002

Provisional Credentialing Status


See bold text below:

(a) A health benefit plan shall have a process for provisional credentialing status in compliance with the requirements of the National Committee for Quality Assurance.

(b) A health benefit plan may grant provisional credentialing status to a physician who:

(1) submits a completed standard credentialing application to the health benefit plan;

(2) meets the health plan’s requirements for provisional credentialing; and

(3) joins as a partner, shareholder, or employee of another physician who is contracted with a health benefit plan to provide medical or health care services to enrollees.

(c) A health benefit plan must complete the credentialing process within 60 calendar days of the date a physician is granted provisional status. In the event the physician does not meet the health plan’s credentialing standards, the physician must be provided the same appeal process as any other physician applying for participation with the health benefit plan.