Date: August 22, 2023
Attention: Primary Care Providers (PCPs)
Call to action: Texas Children’s Health Plan (TCHP) would like to remind Primary Care Providers (PCPs) of the credentialing requirement when administering allergen immunotherapy services.
How this impacts providers: Allergy testing and injections will be reimbursed only for PCPs who are credentialed as allergy specialists. An allergist / immunologist (commonly referred to as an allergist) is a physician specially trained to diagnose, treat and manage allergies, asthma and immunologic disorders including primary immunodeficiency disorders.
TCHP will utilize the American Academy of Allergy, Asthma, and Immunology (AAAAI) guideline in the credentialing of PCPs to provide allergy testing and injections. The guideline states that delivering individuals must have appropriate experience and training. Internists and pediatricians interested in becoming an allergist / immunologist have at least an additional two years of study, called a fellowship, in an allergy / immunology training program. Information on AAAAI guidelines are available at https://www.aaaai.org/.
Next step for Providers: Primary care physicians that would like to receive specialist credentialing for allergen immunotherapy will need to update their PEMS enrollment information on this site, https://www.tmhp.com/topics/provider-enrollment. There are two ways to accomplish this:
- For providers previously enrolled, they select to edit their enrollment information and indicate this in the license, accreditation, and certification section of the application.
- Providers may also add the certification information to the attachment tab in PEMS.
PCPs Notification to TCHP:
- PCPs should complete a Provider Information Form available here and include their W-9 (required). Completed form should be sent to TCHP Contracting Department at tchpnetowrkmanagment@texaschildrens.org.
- PCPs with questions should contact their assigned Provider Relations Liaison or email providerrelations@texaschildrens.org. They may also contact the Contracting Department at 832-828-1004, option 6.
Credentialing Steps:
Primary care physicians that would like to practice as an allergist / immunologist will also need to go through the credentialing validation process, which includes primary source verification of the training and/or board certification to practice in this particular specialty. PCPs should follow the following steps for the validation process:
- The practitioner needs to submit an updated and attested credentialing application via the Council for Affordable Quality Healthcare (CAQH) site, https://www.caqh.org/providers, which houses all required documentation needed for credentialing.
- The credentialing contact for the provider would be responsible for updating this information.
- The application should include the specialty board certification information and/or post-graduate education information such as specialty, institution name, institution address, attendance dates and if the program was successfully completed.
For providers that do not utilize the CAQH site, the application is available on this site, https://www.tdi.texas.gov/hmo/crform.html. A blank Texas Standardized Credentialing Application can be emailed to you. Please contact your Provider Relations Liaison for the application or email providerrelations@texaschildrens.org.
Practitioner Notification of Decision:
PCPs will be notified via their Provider Relations Liaison once the process is complete and the provider is credentialed with the allergist specialty.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
