Initial Credentialing  

1. The department must complete a Provider Request Form "PRF" and forward via email to everyone listed on the PRF.  The PRF template can be found at W:\PUB\Policies\Prov_Req_Form\.

2. When the PRF is received, two separate credentialing and billing enrollment application packets will be delivered.

Credentialing - Managed Care and University Hospitals

• Delivered, completed and returned electronically.
• Due date is 30 days.
• Responsible party:

Credentialing/Medical Staff Services http://www.utsouthwestern.edu:8080/utsw/cda/dept397756/files/399408.html

Billing (Medicare/Medicaid) Enrollment

• Hand delivered and picked up.
• Due date is 30 days.
• Responsible party:

Provider Enrollment http://www.utsouthwestern.edu:8080/utsw/cda/dept300335/files/514299.html

3. Once credentialing is approved by the Credentials Committee, Provider Relations begins the process of submission to each managed care organization "MCO".

Please note:

• The practitioner must have a Texas license with expiration date, DEA and DPS when applicable, and hospital privileges.
• The large managed care organizations do not accept a faculty temporary license.
• The name on the application must exactly match the name on the Texas license.

Questions concerning a practitioner's status with the MCOs should be directed to the Managed Care Help Desk at 214-645-0496.

The current MCO Participation Roster can be found at:

http://www8.utsouthwestern.edu:8080/utsw/cda/dept300335/files/318359.html

or

W:\PUB\Policies\MCO_Roster\