Common use of Expedited Credentialing Process Clause in Contracts

Expedited Credentialing Process. MCOs must comply with the requirements of Texas Insurance Code Chapter 1452, Subchapters C, D, and E, regarding expedited credentialing and payment of physicians, podiatrists, and therapeutic optometrists who have joined established medical groups or professional practices that are already contracted with the MCO. Additionally, the MCO must comply with the Subchapters’ hold harmless requirements for Members. The MCO must complete the credentialing process for a new provider and its claim systems must be able to recognize the provider as a Network Provider no later than 90 calendar days after receipt of a complete application. If an application does not include required information, the MCO must provide the provider written notice of all missing information no later than 5 Business Days after receipt. Additionally, if a provider qualifies for expedited credentialing, the MCO’s claims system must be able to process claims from the provider as if the Provider was a Network Provider no later than 30 calendar days after receipt of a complete application, even if the MCO has not yet completed the credentialing process.