Joining the Network
Cook Children's Health Plan's credentialing process is designed to meet National Committee for Quality Assurance (NCQA) and state requirements for the evaluation of Providers who apply for participation.
Network Development Can Help You With:
- Provider contracts
- Name change
- Address change
- NPI update
- TPI number
To Start the Credentialing Process You Must:
- Enroll as a Medicaid Provider via Texas Medicaid & Healthcare Partnership.
- Complete and submit the Letter of Interest (LOI) Questionnaire via our Secure Provider Portal, select Customer Service from the homepage and topic: Request to Join the Network.
- Providers pending access approval to the Secure Provider Portal can submit the Letter of Interest (LOI) Questionnaire form via email to CCHPNetworkDevelopment@cookchildrens.org or fax to 1-682-885-8403
Once You Have Submitted the LOI, Cook Children's Health Plan will:
- Once reviewed and approved, Network Development will submit your information to the credentialing verification office (CVO), Verisys.
- Verisys will contact the Provider to start the credentialing process, accept the credentialing application, and perform the primary source verification (PSV).
- Facility and Ancillary Providers will use Availity to complete the credentialing application.
- Upon receipt of a completed application and any requested documentation, the credentialing process will be completed within ninety (90) days.
- Providers will sign and return all contract documents including a Form W-9 (Rev.10-2018); older versions will not be accepted.
- Upon complete credentialing and full execution of contract documents, the Network Development Department will send a welcome letter with the effective date of participation, along with the fully executed contract.
- For existing Providers the re-credentialing process will occur every three (3) years or as determined by Verisys through the Texas Credentialing Alliance (TCA). Re-credentialing must be completed to continue participation in the Cook Children's Health Plan network.
Expedited Credentialing for Physicians in a Medical Group
- If an applicant physician meets the qualifications for expedited credentialing, the physician will be treated as a participating Provider for Cook Children's Health Plan for payment purposes under the terms of the medical group's current participating Provider contract.
- Be enrolled with Texas Medicaid and have a valid Texas Provider Identifier (TPI) attested to the participating group.
- Submit all documentation and other information required by the health plan to begin the credentialing process within thirty (30) days.
- Agree to comply with the terms of Cook Children's Health Plan current participating Provider contract with the established medical group. If deemed eligible, the physician will be authorized to collect copayments from Cook Children's Health Plan enrollees and will be paid in accordance with the terms of the medical group's current participating Provider contract.
An applicant physician will not be included in the Cook Children's Health Plan Provider Directory or any list of participating Providers, and will not be eligible for selection as a Primary Care Provider by enrollees, unless and until the physician is credentialed as a participating Provider.
In addition to verifying credentials, the Health Plan will consider Provider performance data including Member complaints and appeals, quality of care and utilization management.