What are the credentialing requirements?
The purpose of this webpage is to provide information about credentialing requirements. You will find rules and statutes that govern the WCNet credentialing processes. You will also find the Texas Standardized Credentialing Application.
Credentialing, as defined by Texas Administrative Code (TAC) §10.82, is the "process for selection and retention of network doctors and health care practitioners" (providers). The credentialing process is part of the required Quality Improvement Program described in 28 TAC §10.81 and Texas Insurance Code, §§1305.301-1305.304. All certified workers' compensation networks are required to document, create policies and procedures, and develop written criteria for credentialing network providers.
The initial credentialing process may begin with a provider submitting a completed Texas Standardized Credentialing Application to the WCNet in which they wish to participate. The WCNet's credentialing committee will verify items such as the applicant's work history, current professional liability insurance, education, board certification (if applicable), history of loss, sanctions or other disciplinary activity. The process may also consist of an on-site visit to assess the applicant's location of practice or facility. The credentialing committee must complete initial credentialing within 180 calendar days prior to the applicant being deemed a credentialed provider. The applicant must be notified of the credentialing committee's decision no later than 60 days after the decision. The WCNet is required to re-credential each participating credentialed provider every 3 years.
As Texas is not an "any willing provider" state, the WCNet is not required to contract with a provider applicant. However, pursuant to 28 TAC §10.82, a provider has the right to review the information submitted to support the credentialing application, correct erroneous information and the right to be informed of the status of their credentialing or re-credentialing application.
For more information contact:
Last updated: 01/30/2012