Department of Quality Management

UT Southwestern Health Systems(UTSHS) has the responsibility for the managed care credentialing/recredentialing process for all UT Southwestern Medical Center practitioners. This process is administered by the Department of Quality Management at UTSHS.
   
We are committed to assisting all UTSWMC clinical departments with every aspect of the managed care credentialing process.

Credentialing is an important process that all UT Southwestern Medical Center practitioners must complete before they can bill a payer for services.  Credentialing and recredentialing processes are designed for accuracy, uniformity and consistency of practitioner information.
   
It is critical that UTSHS maintain its delegated credentialing status with the various managed care payers. To fulfill our delegation contracts, we must comply with the National Committee for Quality Assurance (NCQA), and the Texas Department of Insurance (TDI) standards that govern our payers. Our entire process is structured to meet NCQA & TDI standards. In March 2003 we were audited by NCQA and we passed our third certification audit with no recommendations. The NCQA audit and certification process occurs every 2 years, and we have been certified since 1999 as a physician organization

Not all practitioners complete the entire credentialing process. If a practitioner will treat only Medicare and Medicaid patients, he/she will need Billing enrollment and hospital privileges but not Managed Care credentialing.   

If a practitioner is "research only", he/she may not need to participate in any of these credentialing processes.

If a practitioner will treat Medicare and Medicaid patients, and wants to treat managed care patients (Aetna, United, etc.) then he/she will need to complete the entire credentialing process.

Part time and volunteer practitioners require special handling.  Departments should contact UTSHS Provider Relations to discuss these practitioners.