Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 21 - TRADE PRACTICES
Subchapter X - EVALUATION OF NETWORK PHYSICIANS AND PROVIDERS
Section 21.3201 - Texas Standardized Credentialing Application for Physicians, Advanced Practice Nurses, and Physician Assistants

Universal Citation: 28 TX Admin Code § 21.3201

Current through Reg. 50, No. 13; March 28, 2025

(a) Purpose and applicability. The purpose of this section is to identify the standardized credentialing application form required by Insurance Code § 1452.052. Hospitals, health maintenance organizations, preferred provider benefit plans, and preferred provider organizations are required to use this form for credentialing and recredentialing of physicians, advanced practice nurses, and physician assistants.

(b) Definitions. The following words and terms when used in this section have the following meanings.

(1) Advanced practice nurse--An advanced practice nurse as that term is defined by Occupations Code § 301.152.

(2) Credentialing--The process of collecting, assessing, and validating qualifications and other relevant information pertaining to a physician or provider to determine eligibility to deliver health care services.

(3) Department--Texas Department of Insurance.

(4) Health maintenance organization--A health maintenance organization as that term is defined by Insurance Code § 843.002(14).

(5) Hospital--A licensed public or private institution as defined by Health and Safety Code Chapter 241 and any hospital owned or operated by state government.

(6) Physician--An individual licensed to practice medicine in this state.

(7) Physician assistant--A person who holds a license issued under Occupations Code Chapter 204.

(8) Preferred provider benefit plan--A plan issued by an insurer under Insurance Code Chapter 1301.

(9) Preferred provider organization--An organization contracting with an insurer issuing a preferred provider benefit plan under Insurance Code Chapter 1301 for the purpose of providing a network of preferred providers.

(10) Recredentialing--The periodic process by which:
(A) qualifications of physicians, advanced practice nurses and physician assistants are reassessed;

(B) performance indicators including utilization and quality indicators are evaluated; and

(C) continued eligibility to provide services is determined.

(c) Texas Standardized Credentialing Application. The Texas Standardized Credentialing Application must be used by all hospitals, health maintenance organizations, preferred provider benefit plan insurers, and preferred provider organizations for credentialing and recredentialing of physicians, advanced practice nurses, and physician assistants.

(d) Effective date. The application form is required for initial credentialing or recredentialing that occurs on or after August 1, 2002 for physicians. The application form is required for advanced practice nurses and physician assistants for initial credentialing and recredentialing that occurs on or after May 20, 2003.

(e) Availability. This form may be obtained on the department's website at www.tdi.texas.gov . Reproduction of this form without any changes is allowed.

(f) Electronic submission. The form may be submitted electronically to the credentialing entity in the same format as the hard copy form if the credentialing entity accepts such electronic submissions.

Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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