Becoming a Participating Provider
How to join Texas Children's Health Plan Provider Network
Thank you for your interest in joining Texas Children’s Health Plan network of providers. Interested providers will complete the following steps for consideration to become a participating provider:
Completion of the Network Participation Form
Providers must submit a completed LOI Questionnaire along with a W9 Form to the Texas Children’s Health Plan Network Management Department for consideration. Both documents can be submitted either by fax or email as indicated on the LOI Questionnaire Form. Incomplete LOI Questionnaires and/or missing W9 forms will not be considered.
The Texas Children’s Health Plan Network Management Department will review to ensure the following criteria are met:
Provider is a Texas Medicaid Provider, as applicable
Provides services in one of the Texas Children’s Health Plan service areas
Has admitting privileges at a Texas Children’s Health Plan participating hospital, as applicable
Services provided is a network need for Texas Children’s Health Plan
After review and consideration, Texas Children’s Health Plan’s Network Management Department will notify provider of acceptance or denial of LOI. If accepted, Provider will begin the credentialing and contracting process.
The Credentialing & Contracting Process
Prospective providers will receive an email from Texas Children’s Health Plan, generated through AppCentral, requesting for the completion of the appropriate credentialing application. Prospective providerswill also receive 2 copies of the applicable provider services agreement for review and signature.
Once all completed documents are returned (application and signed contracts), Texas Children’s Health Plan will complete the credentialing process.
Please be advised of the following practitioner rights under NCQA for practitioners who are undergoing the credentialing process:
Practitioners have the right to review information submitted by outside sources (malpractice insurance carriers, state licensing boards, etc.) to support their credentialing application. Texas Children’s Health Plan is not required to make available references, recommendations or peer review protected information.
Practitioners have the right to correct erroneous information identified in their credentialing application. Corrections must be submitted in writing to the Texas Children’s Health Plan Credentialing Department at TCHPCredentialing@texaschildrens.org within (10) days.
Practitioners have the right to receive the status of their credentialing or re-credentialing application, upon request, by emailing the Credentialing Department at TCHPCredentialing@texaschildrens.org. If a practitioner inquires about the status of their credentialing application, the credentialing staff will review the practitioner’s CAQH application and the status of the credentialing file, including pending and/or completed primary source verifications with Verisys. Once the staff determines the completeness and anticipation of credentialing committee review timeframe, the provider will be notified of their credentialing status via email. Credentialing status inquiries received via the provider hotline, will be forwarded by member services to the credentialing department.
Upon successful completion of the credentialing process, Texas Children’s Health Plan’sP Network Management Department will notify the provider of the following:
Letter of network participation acceptance with the provider’s effective date
Counter-signed provider services agreement
New Provider Orientation
The assigned Provider Relations Manager will contact new providers to schedule an in-service for your office regarding Texas Children’s Health Plan’s policies and procedures.
Joining an Existing Contracted Medical Group? Expedited Credentialing May Apply!
Providers joining an existing provider group may qualify for expedited credentialing. Please contact our Provider Network Management Department at the following for more information:
Provider Network Management:
1-832-828-1004, option 6
Texas Children's Health Plan operates in the following areas:
For CHIP and STAR: Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller, Wharton, Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler and Walker counties.
For STAR Kids: Anderson, Angelina, Austin, Bowie, Brazoria, Cass, Chambers, Cherokee, Cooke, Delta, Fannin, Fort Bend, Franklin, Galveston, Grayson, Gregg, Hardin, Harris, Harrison, Henderson, Hopkins, Houston, Jasper, Jefferson, Lamar, Liberty, Marion, Matagorda, Montague, Montgomery, Morris, Nacogdoches, Newton, Orange, Panola, Polk, Rains, Red River, Rusk, Sabine, San Augustine, San Jacinto, Shelby, Smith, Titus, Trinity, Tyler, Upshur, Van Zandt, Walker, Waller, Wharton, and Wood counties.