1. (a) Purpose and Applicability. The purpose of this section is to adopt a standardized credentialing application form as required by the Insurance Code Article 21.58D. Hospitals, health maintenance organizations, preferred provider benefit plans, and preferred provider organizations are required to use this form for credentialing and recredentialing of physicians.

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

   1. (1) 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.
   2. (2) Department--Texas Department of Insurance.
   3. (3) Health maintenance organization--A health maintenance organization as that term is defined by the Insurance Code Article 20A.02(n).
   4. (4) Hospital--A licensed public or private institution as defined by Chapter 241, Health and Safety Code, and any hospital owned or operated by state government.
   5. (5) Physician--An individual licensed to practice medicine in this state.
   6. (6) Preferred provider benefit plan--A plan issued by an insurer under the Insurance Code Article 3.70-3C.
   7. (7) Preferred provider organization--An organization contracting with an insurer issuing a preferred provider benefit plan under the Insurance Code Article 3.70-3C, for the purpose of providing a network of preferred providers.

   8. (8) Recredentialing--The periodic process by which:

      1. (A) qualifications of physicians are reassessed;
      2. (B) performance indicators including utilization and quality indicators are evaluated; and
      3. (C) continued eligibility to provide services is determined.

3. (c) Texas Standardized Credentialing Application.

   1. (1) The Department adopts and incorporates by reference the Texas Standardized Credentialing Application for required use by hospitals, health maintenance organizations, preferred provider benefit plan insurers, and preferred provider organizations for credentialing and recredentialing of physicians.
   2. (2) The application consists of three sections. Section I requests personal, professional, and educational information. Section II consists of disclosure questions on sanctions, professional liability insurance, malpractice claims history, criminal/civil history, and ability to perform job. Section III consists of an Authorization, Acknowledgment, Attestation, and Release form.
4. (d) Effective date. The application form is required for initial credentialing or recredentialing that occurs on or after August 1, 2002.
5. (e) Availability. This form may be obtained on the Department's Web site at www.tdi.state.tx.us or from the Texas Department of Insurance, Quality Assurance Section, HMO Division, Mail Code 103-6A, P. O. Box 149104, Austin, Texas, 78714-9104; or by calling 1-800-599-SHOP (1476); in Austin, 305-7211. Reproduction of this form without any changes is allowed.
6. (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.

Source Note:The provisions of this §21.3201 adopted to be effective July 31, 2002, 27 TexReg 6709.