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7.5.8.5 Credentialing Grievance Committee
The Credentialing Grievance Committee reviews provider requests for reconsideration of credentialing decisions. Applicants who are not approved are notified by certified mail of the denial, the reason for the denial, and the process for reconsideration. Applicants may request reconsideration by submitting evidence that the deficiency(ies) for which the original application was denied has/have been corrected.
A provider has 30 days to request a reconsideration of a recredentialing denial to the Credentialing Grievance Committee. Such requests must be in writing and submitted to the following address:
Primary Care Case Management (PCCM)
Credentialing Grievance Committee
Credentialing Mail Code MC-B05
PO Box 204270
Austin, TX 78720-4270
Members of the Credentialing Grievance Committee
The Credentialing Grievance Committee is composed of the following members:
• Medical Director, HHSC Medicaid and CHIP Programs, or designee.
•Medical Director, TMHP.
•Contracting and Credentialing Manager, TMHP.
•Provider Services Director, TMHP.
•Staff person from HHSC Medicaid/CHIP/PCCM.
Credentialing Grievance Committee Frequency/Logistics
The Credentialing Grievance Committee convenes within 60 days after receipt of a grievance or request for reconsideration. The provider is notified of the date, time, and location of the grievance hearing before the Credentialing Grievance Committee. The provider may attend the grievance hearing.
Notification of the Credentialing Grievance Committee's Decision
The provider is notified in writing of the decision of the Credentialing Grievance Committee within 45 days after adjournment of the hearing. The Credentialing Grievance Committee forwards its recommendations to HHSC following the hearing.
A decision of the Credentialing Grievance Committee may be submitted for reconsideration to:
Texas Health and Human Services Commission
Office of General Counsel
4900 N. Lamar, 4th Floor
Austin, TX 78751
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