Effective September 1, 2007, physicians joining a medical group may apply for provisional status to be paid for services provided to Blue Cross Blue Shield of Texas (BCBSTX) enrollees as if they were participating in our managed care network(s) through your
agreement(s) with us, pending completion of a physicians' credentialing for network participation ("Provisional Status"). This informs the medical group of BCBSTX guidelines for implementation of the new state law (HB 1594) which allows for this Provisional Status.

Following are the criteria that must be met in order for a physician to be considered eligible for Provisional Status:

• Applies only to physicians who are subject to BCBSTX credentialing (MD/DO) whose previous credentialing application has not been denied or whose BCBSTX network participation has not been terminated for cause by BCBSTX.
• The physicians must have joined a medical group that is contracted under a medical group agreement with BCBSTX for network participation.
• Hospital based physicians in contracted medical groups are not credentialed: their medical groups must submit a short form application for expedited review to attain their network status.
• The physician must submit a complete current Texas Standardized Credentialing Application (TSCA) as well as all other documentation/information required to begin the credentialing process.
  (CAQH Users, please contact CAQH for instructions in downloading your information to the TDI Credentialing application.)
  • TSCA
  • TSCA Completion Guidelines
  
  
• The BCBSTX Cover Page to the TSCA must indicate the physician’s request for Provisional Status and include a fully executed Provisional Status Addendum under which the physician and the medical group agree that the physician will be subject to applicable provisions of the medical group's managed care agreement(s) with BCBSTX.
  • Cover Page including Provisional Status Addendum
  • Cover Page Only
  • Provisional Status Addendum Only
  
  

• The Provisional Status Addendum must be signed by one of the following authorized representative of the group:

  • CEO
  • President
  • Executive Director
  • Managing Director
  • Administrator

Note:  Otherwise a written authorization from such an officer designating the representative who is authorized to sign is required.

• The physician’s license must be in good standing with the Texas Medical Board with no history of disciplinary actions.
• The physician’s professional liability history must meet BCBSTX criteria.