Full Implementation of the Credentialing Verification Organization (CVO) to Begin April 2018

Date: 02/22/18

The Texas Association of Health Plans (TAHP) in collaboration with the Texas Medical Association (TMA) and Medicaid Managed Care Organizations are excited to announce a joint effort to reduce credentialing burdens for all Texas providers including physicians, allied health practitioners, hospitals, facilities and all ancillary providers including LTSS (herein we will refer all of these types as providers). TAHP and TMA selected Aperture, LLC, for a statewide Credentialing Verification Organization (CVO) contract used by all 20 Medicaid health plans in Texas to streamline the provider credentialing process. Moving forward, this initiative will be referred to as the Texas Credentialing Alliance (TCA).

What Should Providers Expect in April 2018?

Beginning in April 2018, all new and providers currently contracted with a Medicaid MCO will begin to receive notifications from Aperture regarding initial credentialing events and information about the common recredentialing date.

The CVO will eliminate administrative burdens by adopting a single re-credentialing date (recredentialing must occur no less than every 3 years). For example, if you participated with 3 health plans you would have 3 different recredentialing dates. With a common date, you have one recredentialing date.

To achieve this simplification, you may need to be recredentialed for some MCOs before the 3-year period ends; however, once the common date is established, the recredentialing will reoccur on a 3-year cycle for all MCOs that you participate.

How the CVO Works:

As done today, you will continue directly contacting the plan(s) you wish to contract with, but you do not need to submit a credentialing application to the plan(s). The MCO(s) will notify Aperture, the CVO, to begin the credentialing process with you. Aperture will reach out to providers to start the credentialing process and will also accept the credentialing application and perform the primary source verification (PSV) that includes verification of your application, license and all applicable licenses/documents.

The Council for Affordable Quality Healthcare (CAQH) will remain available for practitioners and health professionals who currently use it and a new solution will be offered for ancillaries and facilities through Availity beginning April 2018. Paper applications will continue to be accepted by Aperture.

The credentialing process is separate from the contracting process. Providers will still need to engage with the MCO for contracting needs and provide any additional information to complete the credentialing process.

Providers enrolling in Texas Medicaid and CHIP through Texas Medicaid & Healthcare Partnership (TMHP) must still follow the processes as provided by TMHP/HHSC. Providers must complete the enrollment process through TMHP/HHSC prior to credentialing with the MCO(s).

Benefits:

Saves time by eliminating duplicative efforts and processes for providers who credential and re- credential separately with multiple MCOs.
Lowers administrative costs for providers and MCOs.
Utilizes existing web-based portals (CAQH and Availity) to access provider credentialing application information, allowing providers who use those portals to easily update and maintain their application information for multiple product lines.

Please see below for additional resources from Texas Health and Human Services:

For any quesions, please reach out to your local Account Manager.