tialing purposes could go even further to alleviate access-to-care delays by making it easier for physicians to par- ticipate in those networks. “I have one provider who needs to be in network, and I have to hold claims up” because of lags in enroll- ment processing, says Mary Dale Pe- terson, MD. She is president and chief executive officer of Driscoll Children’s Health Plan in Corpus Christi and a member of TMA’s Select Committee on Medicaid, CHIP, and the Unin- sured. “It creates complications for health plans and for doctors. I’m not allowed, based on state rules, to pay until I get their [Medicaid enrollment] number.” Medicaid HMOs also must follow
various rules and quality standards set up by the Texas Department of Insur- ance and health plan accrediting bod- ies that require background checks to verify physicians’ professional quali- fications: everything from education, training, and licensure to liability coverage, claims history, and hospital privileges. “We take that seriously, and of
course, having the right network of doctors is really critical,” Dr. Peterson said. “We don’t want to give that up. But we’re looking at ways to make it easier for everybody.” One option: Instead of physicians filing the same information again with each Medicaid HMO — there are at least 20 in Texas — and health plans processing duplicative paperwork, all parties seem to align over the poten- tial for a centralized, statewide cre- dentialing verification organization. Physicians would go to one place to submit their information; health plans would go to the same place to retrieve what they need to complete their cre- dentialing processes.
The idea, while not new, finally
gained traction after the 2013 Texas Legislature passed Senate Bill 1150, calling on HHSC to develop a plan specifically to reduce such administra- tive burdens on physicians and other health professionals participating in
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August 2015 TEXAS MEDICINE 57
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