Texas Insurance Code 1457.002 – Provisional Credentialing Status
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(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.
Terms Used In Texas Insurance Code 1457.002
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
(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.