Are You Eligible for “Expedited Credentialing?”
By David Doolittle

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If you’re completing health plan credentialing, “expedited credentialing” might apply to you. And if it applies, that could be good for you and your practice.  

But how do you know if it does? 

  • Are you a physician joining an established medical group that has a current contract in force with a managed care plan?
  • Is the established medical group made up of two or more physicians?
  • Are you licensed in this state by, and in good standing with, the Texas Medical Board?
  • Have you submitted all documentation and other information that the managed care plan requires to include you in their network?
  • Have you agreed to comply with the terms of the plan's participating provider contract currently in force with the established medical group? 

If you answered “yes” to all of the above, expedited credentialing applies to you. 

And that means during the credentialing process the insurance company is supposed to treat you as if you were a participating provider, for payment purposes only. So you should be paid as if you are in-network with the health plan. 

If you eventually fail to meet the health plan’s credentialing requirements, the plan could recover an amount equal to the difference between payments for in-network benefits and out-of-network benefits. 

Of course, the Texas Medical Association is here to help you resolve any insurance-related problems through its Hassle Factor Log program.

Last Updated On

August 28, 2019

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Credentialing | Insurance

David Doolittle

Editor

(512) 370-1385

Dave Doolittle is editor of Texas Medicine and Texas Medicine Today. Dave grew up in Austin, where he attended culinary school as well as the University of Texas. He spent years covering Central Texas for the Austin American-Statesman newspaper. He is the father of two girls, a proud Longhorn, and an avid motorsports fan.

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