Recredentialing
All practitioners are recredentialed for MCO participation every three years. Four months prior to the three-year anniversary the practitioner will receive a TDI Standardized Credentialing Application that includes all of the information that was provided and verified on the initial application. Practitioner must review, update and sign the application.
In addition to the completed application form, the applicant submits copies of the following documents:
a. Current Texas state license
b. Current DEA and DPS, if applicable
c. Board Certification, if applicable
d. Certificate of medical liability insurance coverage showing limits of liability and effective dates.
e. Description of all malpractice claims history.
Once all data elements are verified, practitioners are presented to the UTSHS Credentialing Committee for formal recredentialing. Once approved, Provider Relations submits updated data, as appropriate, to payers.
If practitioners are not recredentialed by their due dates, they may be deactivated from MCO participation.
The UTSHS Credentialing staff has implemented a courier service for the convenience of all departments and for the privacy of practitioner information. All initial and re-credentialing packets are hand delivered and picked up as soon as they are completed. The courier service runs on Tuesdays and Thursdays at 9:30 am. If an urgent pick up or delivery is needed please contact us, at 5-0321.
UTSHS tracks both initial and re-credentialed practitioner's status on the Primary Source Verification (PSV) report. This report is sent twice a month to all clinical department credentialing contacts. It details where each practitioner is in the managed care credentialing process.
The re-credential packets are required to be returned within 30 days. If not completed and returned within 30 days, a letter will be sent to the Vice President for Clinical Operations. He will contact the Department Chair regarding the practitioner's lack of response.
Information provided by the applicant is verified via the National Practitioner Data Bank, State/Federal boards
and other institutions and/or agencies as necessary.
Practitioner credentialing data is then presented to UTSHS Credentialing Committee for evaluation and Committee vote.
