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Texas Standardized Credentialing Application

Word, RTF and PDF versions are available on the Credentialing Application forms page.

The Texas Standardized Credentialing Application fulfills requirements of Senate Bill 544 (Acts 2001, 77th Leg., ch. 1369, §3, effective Sept. 1, 2001), providing for the Texas Insurance Commissioner to adopt a standardized form for verification of physician credentials.

Use of the application form by hospitals, HMOs and PPOs is required for credentialing of physicians. Hospitals and health plans may use this application for the credentialing of other health care professionals, as well.

The credentialing form is based on one developed by the Coalition for Affordable Quality Healthcare.

General Instructions:

If you experience problems in downloading the credentialing form, please remember it's always best to SAVE the form to your computer before opening or viewing. Those using a PC should "right click" on the form version they want to download and use the "Save Target As" option to save the file to their desktop or elsewhere.

The "right click" option is especially helpful if you are experiencing conflicts with virus checkers or other programs on your computer. If you are using a Macintosh, hold the option key while clicking on the form's link and, in the dialog box, select a folder in which to save the document.

Fix for Word 2003 Format Problem

If your credentialing form does not format and print properly after switching to Word 2003 from Word 97, it is likely tied to the way that Word 2003 works with "tracked changes." In the Word 2003 version of your form, go into Tools, click on "Options" and look for the "Track Changes" tab. On that tab, change the Track Changes options to (none) and uncheck the "Use balloons in Print and Web Layout." Re-save your form and recheck the formatting. If you still have a problem, email us at HWCN@tdi.texas.gov.

Otherwise, you can download the credentialing form as follows:

  • Click your mouse cursor on the form name (LHL234.doc, for example) to open it in Word, (LHL234.rtf) to open it in another word processor or (LHL234.pdf) to open it in Adobe Acrobat Reader. Then use your word processor or Adobe Acrobat or Acrobat Professional - not the free Adobe Acrobat Reader - to save the file to your computer.
  • The text fields in each area of the Word form should be gray and empty when not selected and black when selected and ready for text to be added. If a blank Word form is printed for use on a typewriter, the field area should be blank, as well. If you see {FORMTEXT} or {FORMCHECKBOX} in the field area, you need to adjust Word. Go to the Tools Menu and choose Options. Click on the Print tab and make sure the Field Codes box is not checked, then click on OK. That should allow you to print a blank Word form.

Filling Out Application Form

Interactive Word/RTF Forms

  • The RTF version can be opened by all but the very basic word processors. Rich Text Format (rtf) is a standard file format which can simplify the exchange of document files between different word processors or computer operating systems. For example, you can send an RTF file created in Microsoft Word 97 in Windows 98 to someone who uses WordPerfect 6.0 on Windows 3.1 or StarOffice on a Linux system or Word 5 on a Macintosh system and they will be able to open the file and read it.
  • Interactive Word and RTF forms can be saved to your computer and opened whenever needed. Information you type into the form will be saved if you have the full Word software -- not the free Word viewer. If you fill in a Word form using the free Word viewer and close it, it will be blank when you open it again.
  • Saving the completed form electronically is possible with the purchase of Word (Word 97 or newer). The RTF version can be saved with Word or other full-version word processors.
  • How to Fill Out the Form - The Word and RTF versions allow you to fill in your application on-screen, save it, print it out and mail it or e-mail it. To begin entering data:

    (1) Point your mouse arrow to the blank area of the first form field. The gray rectangle (field) will turn black and you can type in your response.
    (2) For a check box or radio button, tab to the proper one and hit the spacebar to accept it. Be careful to use the spacebar only on the appropriate check box. Word will allow you to check more than one. You also may use your mouse pointer to click on the proper check box or radio button.
    (3) Hit the tab key to continue moving from one form field or check box to the next. To go back to the previous form field, hold down the "SHIFT" key before tabbing.
    (4) If you hit the enter key in a form field, the cursor disappears. Click your mouse pointer in the field, and the cursor returns and you can continue to fill out the form.
    (5) IMPORTANT - If you are using the free Word viewer, be sure to make a print out before closing the document. Your data will disappear when you close the free Word viewer.
    (6) The fields in the Word forms can expand to fit the amount of information you type into them. Please use the minimum number of words possible. If you go beyond the space initially allocated, Word will expand to fit the material added. When that happens, the form "pushes" itself out of shape. Parts of pages may move over to the next page, leaving the excess on a mostly blank page and forcing the form to expand in length.

Interactive PDF Forms (NOT YET AVAILABLE)

Important! If you close the interactive PDF version of this form, you will lose the information you typed on the screen. Be sure to print a copy before closing the form.

  • Interactive PDF forms can be saved to your computer and opened whenever needed. However, information you type into the form is NOT saved, if you fill it in using the free Acrobat Reader. If you close it and open it again, it will be a blank form.
  • Saving the completed form electronically is possible with the purchase of Adobe Acrobat Professional software.
  • How to Fill Out the Form - The PDF version allows you to fill in your application on-screen, print it out and mail it. To begin entering data:

    (1) Select the hand-shaped tool in the Acrobat Reader toolbar.
    (2) Click on the first field in each form field. The "open hand" pointer will change to an "I-beam" as you move or tab to the next form field, allowing you to type text.
    (3) For a check box or radio button, tab to the proper one and hit the space bar to accept it. You can also hit the "enter" key, but using the space bar leads to fewer problems.
    (4) Hit the tab key to continue on moving from one form field or check box to the next. To go back to the previous form field, hold down the "SHIFT" key before tabbing.
    (5) You can also use the pointer for a check box or radio button. The pointer will change to a pointing hand or arrow as you move over a check box. Click the mouse when the hand is pointing at the check box.
    (6) If you hit the enter key in a form field instead of a check box, the cursor disappears. Click your mouse in the field, and the cursor returns. If you hit enter again after the cursor disappears, the screen will jump toward the bottom of the page. To recover, scroll back to the form field you need to enter, click the mouse to make the cursor return and continue to fill out the form.
    (7) IMPORTANT - Before closing the document or trying to save it, be sure to make a print out. See caution above about data not being saved. Printing PDFs can be slow.

For more information, contact:

Last updated: 9/6/2014