Texas Department of Insurance
www.tdi.state.tx.us - Consumer Helpline 1-800-252-3439
Texas Department of Insurance - Texas Standardized Credentialing ApplicationWord, RTF and PDF Versions Available The Texas Standardized Credentialing Application fulfills requirements of Senate Bill 544 (Acts 2001, 77th Leg., ch. 1369, §3, eff. 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. 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." Resave your form and recheck the formatting. If you still have a problem, email us at HMOGrp@tdi.state.tx.us.
Filling Out Application FormImportant!- If you close the 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.
Frequently Asked QuestionsWhich form should providers use, the pre-July 1 form already in physicians' databases, or the version currently posted on the TDI Web site? Effective January 1, 2007, providers will need to use the form currently posted on the TDI web site. However, during the transition from the old form to the new form, TDI trusts that credentialing entities will be flexible and accept the previous form for a period of time. What is the Texas Standardized Credentialing Application? Physicians can use the new application form for initial credentialing and recredentialing by all public and private hospitals, HMOs and PPOs. It allows a physician to complete the form by computer or on paper and print or photocopy it for each hospital, HMO and PPO. Does the Texas Standardized Credentialing Application include everything a hospital, HMO or PPO will need?Not necessarily. Some hospitals and health plans may request additional information. The application comes in three formats (Word, Rich Text Format (RTF) and Acrobat PDF). How do physicians obtain a copy of the Texas Standardized Credentialing Application?The application will be available for downloading from this Web page and will be available for distribution by hospitals, HMOs and PPOs. How do physicians submit the Texas Standardized Credentialing Application?Hospitals, HMOs and PPOs will establish submission procedures for the form. The Word and RTF versions of the form allow you to fill it out on your computer and save it at any time. It can be printed and mailed or faxed or e-mailed as an attachment if the credentialing entity permits. The current PDF version of the form allows you to fill out the form on your computer and print it out for mailing or faxing. You cannot save the data in the completed PDF form on your computer, however, unless you have Adobe Approval or Adobe Acrobat 7.0 Professional. How will physicians keep the information current?The Word and RTF versions of the form allow you to save data at any time. You also can open it and revise it as needed. The current PDF version of the form allows you to fill out the form on your computer and print it out for mailing or faxing if you have only the Adobe Acrobat Reader. You can save a filled out PDF form if you have Adobe Approval or Adobe Acrobat 7.0 Professional. You also may fill out the Word, RTF or PDF form by hand or by using a typewriter if permitted by your credentialing authority. Will the form change?The application form is effective as of January 1, 2007. With the exeption of making the pdf forms web-enterable, No changes in the form are expected in the near future. We need to make some changes to the TSCA so that we can merge it with our database. Can TDI provide us with an "unlocked" or "unprotected" version of the form?No. We have only protected Word, RTF and PDF versions available for download from our Web site. The form was developed to meet the requirements of Senate Bill 544, 77th Legislative Session. It is important that the application remain uniform and standardized. Have other medical groups found a way to use the "protected" form?Yes. A number of groups have arrived at solutions without the need for an "unprotected" or "unlocked" version of the form. We still can't make it work with our software. What do we do now?If you are affiliated with an organization that performs credentialing functions for a large number of phyisicians, you may find it helpful to contact your software vendor. The vendor may have a way to set up your software so that it can use the form in its current format. Which plans accept the Texas Standardized Credentialing Application?By law, all public and private hospitals, HMOs and PPOs must use the application for credentialing and recredentialing of physicians. Texas Department of Insurance Created/Updated: For more information contact: Last updated: 04/09/2007 |