Medicaid Credentialing Made Simple
By Sean Price Texas Medicine January 2018

TMA's new partnership will help ease this burden on Texas physicians

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Practice Management Feature — January 2018

Tex Med. 2018;114(1):46-47. 

By Sean Price

A new partnership by the Texas Medical Association and the Texas Association of Health Plans (TAHP) will soon streamline the process of getting credentialed ― and recredentialed ― for Medicaid health plans. 

In the eyes of many physicians, Medicaid ― the joint state-federal health insurance for low-income people ― is the ugly stepchild of medical payment plans. TMA research shows that only about half of Texas physicians will take all new Medicaid patients. 

"If you look at reasons for which physicians don't accept Medicaid," said Ryan Van Ramshorst, MD, chair of TMA's Select Committee on Medicaid, CHIP, and the Uninsured, "No. 1 is inadequate payment, and No. 2 is administrative burden and red tape."

Little can be done about payment levels without help from lawmakers. But starting in March, a joint program designed by TMA and TAHP will begin reducing the administrative burdens and red tape. 

TMA and TAHP selected Aperture LLC to set up a statewide credentialing verification organization that all 19 participating Medicaid health plans in Texas will use to streamline the provider credentialing process. 

Jamie Dudensing is chief executive officer of TAHP, the statewide trade association representing health insurers, health maintenance organizations, and other related health care entities. Currently, any provider who wants to accept all 19 participating Texas Medicaid plans must fill out 19 separate credentialing applications, she says. Applications can be 30 to 40 pages long and require in-depth information that takes time to assemble.

"[The applications require information like], Is you license in good standing? Are you a risk for waste, fraud, and abuse?" she said. "These are all boxes that need to get checked, but is there any reason they need to get checked 19 different times for the 19 health plans?" 

In 2015, the Texas Legislature passed Senate Bill 760, which requires all managed care organizations that contract within Medicaid to streamline the credentialing and enrollment process for physicians and other providers. Arizona and a handful of other states had already begun consolidating the Medicaid credentialing process, Ms. Dudensing says. TAHP used Arizona's template to streamline the process in Texas.

"We thought it was important to partner with TMA and other physician groups to make sure we're solving the problem," she said.

Ernest Buck, MD, chief medical officer for the Driscoll Health Plan, said first-time applications for credentialing with Medicaid will be much easier under the TMA-TAHP project.

"Remember when you applied to college?" he said. "You filled out a central application, and then you said, 'I want it sent to these seven schools.' And each school charged $50, but you only had to pay the national organization once. That's pretty much the model [for the Texas credentialing verification organization, or CVO], but I anticipate the Medicaid managed care organizations will be footing the bill."

The main benefit of the CVO will come when physicians renew their credentials ― or recredential ― with each plan, Ms. Dudensing says. Right now, each of the 19 participating Medicaid plans has a different deadline for renewal. As a result, physicians are constantly in recredentialing mode.

"[Arizona's program] found a way to get everyone on the same cycle for recredentialing, too," she said. "So that way, every provider wasn't being recredentialed every two months for a different plan. Every three years, they could get recredentialed. There it was ― it was done."

Dr. Van Ramshorst says the similarly simplified recredentialing in Texas will undoubtedly lower overhead costs for physicians.

"It will save staff time for sure," he said. "We have more than 100 different providers in this large group that I'm part of, and it takes a tremendous amount of staff time to stay current with all these [health plans]. So if there's one way to do this, I think it's this way."

Ms. Dudensing says at first the program will generate more work for Medicaid health plans as they adjust the recredentialing cycles. But after the first three years, the plans will see significant savings in staff time. 

Ultimately, she says, the cost savings physicians see will improve Medicaid services.

"A lot of physicians who come in and take care of Medicaid patients are really doing this because they have a mission for it," she said. "We need to remove all the obstacles and burdens that they have and have to deal with every day so that their money's going a lot further and they have time to deal with their patients."

Once the program is on solid footing, TAHP plans to open it up to Medicare Advantage plans and commercial health plans such as Aetna and Blue Cross and Blue Shield of Texas, Ms. Dudensing says. 

"We'll start bringing in our plans one at a time on a voluntary basis to show that this is not just more efficient and reduces provider burden, but [reduces the] burden and administrative costs for health plans too," she said.

Physicians, health practitioners, and other health professionals will still be able to do credentialing through traditional outlets like the Council for Affordable Quality Healthcare and Availity. But Dr. Van Ramshorst says that the TMA partnership with TAHP demonstrates the impact physicians can have on setting policies that affect their business relationships. 

"This shows that managed care organizations are hearing the needs of the practicing providers," he said. "[And that] shows that there is cooperation on a level that I think is really important."

Sean Price can be reached by phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email


Last Updated On

January 10, 2018

Originally Published On

December 28, 2017

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Sean Price


(512) 370-1392

Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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