Medical Credentialing Services in Texas

Julieta Avendano
Image of doctors walking with the outline of Texas overlayed

Even though the saying is “everything is bigger in Texas,” that doesn’t necessarily apply to credentialing applications or wait times. In my experience, completing medical credentialing in Texas is a quicker and smoother process than in many other states. There are some types of providers which are harder to enroll due to limited market options, but for the most part, completing medical credentialing services in Texas is enjoyable. 

What’s Unique About Medical Credentialing in Texas

While much of the credentialing and payer enrollment processes are the same in Texas as in other states, here are a few things to be aware of:

Availity Is Used Consistently

In Texas, Availity is used consistently to complete credentialing and enrollment processes.  However, the processes have not been standardized enough so that a single provider application can be processed through different insurances only by submitting it through Availity. 

Texas Standardized Credentialing Application (TSCA)

In Texas, the Texas Standardized Credentialing Application (TSCA) is required for hospitals, HMOs, and PPOs. The interactive PDF is available through the Texas Department of Insurance, but providers or credentialers can easily download a pre-filled application from CAQH — the format changes slightly per payer, but it includes almost the same information as any other “standard” application. 

No Medicaid Identification Numbers

As of September 1, 2021, Texas stopped assigning Medicaid identification numbers, formerly known as a “TPI number.” Now, the provider’s NPI is used as an identifier. 

Steps To Complete Provider Credentialing in Texas

Medical credentialing services in Texas can be too much work for a single person, and without a system that allows them to be on track, it’s even more difficult.

Here are the general steps involved in completing medical credentialing in the state of Texas:

  • Set Up Online Portals. Since many insurers use the TSCA, ensuring the provider’s CAQH profile is up to date is critical. If the provider will be enrolling with Medicare and the Texas Medicaid program, you’ll also want to set up the Provider Enrollment and Management System (PEMS) profile.
  • Primary Source Verification. Primary source verification involves contacting original sources — such as educational institutions, licensing boards, and certification bodies — to confirm the authenticity and accuracy of the documents and qualifications provided by the provider. Payers in Texas have specific requirements.
  • Work History and Reference Checks. To assess the provider’s experience and reputation within the healthcare community, the work history of the provider must be verified without any gaps longer than 30 days. 
  • Background Checks. Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags. 
  • Payer Enrollment. Providers must be enrolled with every payer they accept insurance from — again, before they start seeing patients. With an average of 5 – 10 payers per provider, this can be a time-consuming and tedious step that needs to start early in the credentialing process. 
  • Privileging. Privileging involves the collection and review of a provider’s documentation to determine if they’re worthy to provide care to patients within a specific institution. All providers must receive privileges at the facility where they will see patients before they begin practicing. 

Tips To Speed Up Credentialing in Texas

While the time it takes to credential providers in Texas can vary, enrollments can be completed within two months for most providers. There are some indications that payers prioritize enrollments with larger medical groups/clinics tend to receive approval letters quicker than smaller businesses. 

The exact timeline depends heavily on the provider’s specialty, volume of providers, and the efficiency and completeness of the provider’s documentation.

1. Start as soon as the provider is hired.

Make sure you start collecting documents as soon as possible and, if enrolling with Texas Medicaid, encourage the provider to set up a PEMS portal as soon as possible. Credentialing early will also alert you to any red flags or complications early in the hiring and onboarding process. 

2. Make it easy for providers to submit documents.

It is much easier for you and the provider to request digital documents as opposed to collecting a paper credentialing packet. Credentialing software offers the ability for providers to securely submit documents to an online portal. 

3. Request a group roster

If you have at least 10 providers, request a group roster from each payer to quickly gather important information such as effective date, recredentialing date, and lines of business. If you aren’t able to get a group roster, then you’re left to gather this information individually for each provider, from every payer.

4. Set reminders and notifications.

Payers may not let you know the upcoming recredentialing date for your providers, and the date could always be moved earlier if there are internal changes with private payers. It’s important to schedule recredentialing reminders as soon as you complete the credentialing process so you don’t miss a deadline. Reminders are also helpful during the process when there are additional steps required to complete the action. Credentialing software can automate these reminders to ensure you don’t miss steps or deadlines.

View this guide for more tips on speeding up your credentialing process.

Keep Credentialing Organized for Texas Providers 

A long process, with some parts online and some on paper, makes medical credentialing in Texas a challenge. Using medical credentialing services in Texas can help to speed up the process because these credentialing specialists are used to the rules and regulations. In many cases, they have also developed good working relationships with the payers, which can smooth the process. 

Find out how MedTrainer can help — whether you just need software or you’re looking for credentialing services to handle the process for you.