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