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7.5.8.4 Credentialing Committee Action
The TMHP Medical Director, as the Co-Chair, is charged with implementing the credentialing and recredentialing standards for participating providers in PCCM. The HHSC Medical Director also reviews submitted documentation and recommends acceptance or rejection of each provider.
When a primary care provider's PCCM credentialing file is complete, the TMHP Medical Director and Credentialing Committee verify all credentials and present their findings to the HHSC Medical Director for Medicaid and CHIP Programs (HHSC Medical Director), at the Credentialing Committee meeting. The HHSC Medical Director reviews the credentials and determines whether the applicant meets HHSC credentialing criteria. The decision to accept a provider as a PCCM primary care provider is made by HHSC in accordance with basic credentialing standards.
Based on this action, the HHSC executes the contract of approved providers. PCCM then notifies each approved applicant in writing of the application's status. For approved providers, the notification includes:
• A fully executed provider contract.
•The date upon which the contract is effective.
•Conditions of participation in PCCM.
•Recredentialing requirements.
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