28 Tex. Admin. Code § 21.3201 - Texas Standardized Credentialing Application for Physicians, Advanced Practice Nurses, and Physician Assistants
(a) Purpose and applicability. The purpose of
this section is to identify the standardized credentialing application form
required by Insurance Code §
1452.052. Hospitals,
health maintenance organizations, preferred provider benefit plans, and
preferred provider organizations are required to use this form for
credentialing and recredentialing of physicians, advanced practice nurses, and
physician assistants.
(b)
Definitions. The following words and terms when used in this section have the
following meanings.
(1) Advanced practice
nurse--An advanced practice nurse as that term is defined by Occupations Code §
301.152.
(2) Credentialing--The process of collecting,
assessing, and validating qualifications and other relevant information
pertaining to a physician or provider to determine eligibility to deliver
health care services.
(3)
Department--Texas Department of Insurance.
(4) Health maintenance organization--A health
maintenance organization as that term is defined by Insurance Code §
843.002(14).
(5) Hospital--A licensed public or private
institution as defined by Health and Safety Code Chapter 241 and any hospital
owned or operated by state government.
(6) Physician--An individual licensed to
practice medicine in this state.
(7) Physician assistant--A person who holds a
license issued under Occupations Code Chapter 204.
(8) Preferred provider benefit plan--A plan
issued by an insurer under Insurance Code Chapter 1301.
(9) Preferred provider organization--An
organization contracting with an insurer issuing a preferred provider benefit
plan under Insurance Code Chapter 1301 for the purpose of providing a network
of preferred providers.
(10)
Recredentialing--The periodic process by which:
(A) qualifications of physicians, advanced
practice nurses and physician assistants are reassessed;
(B) performance indicators including
utilization and quality indicators are evaluated; and
(C) continued eligibility to provide services
is determined.
(c) Texas Standardized Credentialing
Application. The Texas Standardized Credentialing Application must be used by
all hospitals, health maintenance organizations, preferred provider benefit
plan insurers, and preferred provider organizations for credentialing and
recredentialing of physicians, advanced practice nurses, and physician
assistants.
(d) Effective date. The
application form is required for initial credentialing or recredentialing that
occurs on or after August 1, 2002 for physicians. The application form is
required for advanced practice nurses and physician assistants for initial
credentialing and recredentialing that occurs on or after May 20,
2003.
(e) Availability. This form
may be obtained on the department's website at www.tdi.texas.gov . Reproduction of this form
without any changes is allowed.
(f)
Electronic submission. The form may be submitted electronically to the
credentialing entity in the same format as the hard copy form if the
credentialing entity accepts such electronic submissions.
Notes
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