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Cook Children's Health Plan

Joining the Network

Provider and Kid

Joining the Network

Cook Children's Health Plan's credentialing process is designed to meet National Committee for Quality Assurance (NCQA) and state requirements for the evaluation of providers who apply for participation.

Network Development can help you with:

  • Credentialing
  • Provider contracts
  • Name change
  • Address change
  • NPI update
  • TPI number

To start the credentialing process you must:

Once you have submitted the LOI, Cook Children's Health Plan will:

  • Review the forms for the following.
    • You are in the Service Delivery Area (SDA)
    • Your request for participation is a service needed by the Managed Care Organization (MCO)
    • All information submitted is complete and correct
  • Once reviewed and approved, Network Development will submit your information to the credentialing verification office (CVO), Aperture, LLC.
  • Aperture will reach out to you to start the credentialing process, accept the credentialing application, and perform the primary source verification (PSV).
    • Practitioners can access CAQH to update and submit the credentialing application
    • Facility and ancillary provider will use Availity to complete the credentialing application
  • Providers should contact Network Development for credentialing and contracting quetions or for corrections of information.
  • Upon receipt of a completed application and any requested documentation, the credentialing process will be completed within ninety (90) days.
  • New providers will be sent a participating provider agreement.
  • Sign and return all contract documents including a Form W-9 (Rev. 10-2018); older versions will not be accepted.
  • Upon complete credentialing and full execution of contract documents, you will receive notice from the Network Development Department with the effective date of participation, along with the fully executed contract (if it is a new contract).

For existing providers the re-credentialing process will occur at least every three (3) years or as determined by Aperture through the Texas Credentialing Alliance (TCA). Re-credentialing must be completed to continue participation in the Cook Children's Health Plan network.

Additional resources for Providers can be found on the Health and Human Services (HHS) website.

Practitioner Rights

When the credentialing process is initiated for practitioners and organizations, the applicant is entitled to:

  1. Review information submitted to support their credentialing application
  2. Correct erroneous information
  3. Receive the status of their credentialing or re-credentialing application, upon request

Providers may contact the Network Development team for credentialing, contracting, and corrections of erroneous information by phone 888-243-3312, fax 682-885-8403 or email CCHPNetworkDevelopment@cookchildrens.org.

Expedited credentialing for physicians in a medical group

Any physician who joins an established medical group that has a current contract in force with Cook Children's Health Plan may apply for expedited credentialing for payment purposes pending completion of the credentialing process. If an applicant physician meets the qualifications for expedited credentialing, the physician will be treated as a participating provider for Cook Children's Health Plan for payment purposes under the terms of the medical group's current participating provider contract.

For expedited credentialing, a physician must:

  • Be currently licensed in Texas and be in good standing with the Texas Medical Board.
  • Be enrolled with Texas Medicaid and have a vaild Texas Provider Identifier (TPI) attested to the participating group.
  • Submit all documentation and other information required by the health plan to begin the credentialing process within 30 days.
  • Agree to comply with the terms of Cook Children's Health Plan current participating provider contract with the established medical group. If deemed eligible, the physician will be authorized to collect copayments from Cook Children's Health Plan enrollees and will be paid in accordance with the terms of the medical group's current participating provider contract.

If Cook Children's Health Plan determines that the applicant physician does not meet their credentialing criteria or is denied participation under the terms of their Credentialing Plan, the applicant physician or the medical group may retain any copayments collected or in the process of being collected as of the date that Cook Children's Health Plan determines the applicant physician will not be credentialed.

An applicant physician will not be included in the Cook Children's Health Plan Provider Directory or any list of participating providers, and will not be eligible for selection as a primary care provider by enrollees, unless and until the physician is credentialed as a participating provider.

In addition to verifying credentials, the Health Plan will consider provider performance data including Member complaints and appeals, quality of care and utilization management.

Contact Network Development

Phone: 1-888-243-3312
Fax: 1-682-885-8403
CCHPNetworkDevelopment@cookchildrens.org

Available 8 a.m. to 5 p.m. Monday through Friday (except for State Holidays).