PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

Provider Participation Requirements
Credentialing of Physicians and Licensed Independent Practitioners
Credentialing shall be required for physicians and licensed independent practitioners. Credentialing is not
required for providers who furnish services under the direct supervision of a physician or provider or hospitalbased
physicians or providers who only provide services incidental to hospital services.
Initial credentialing process for physicians and individual providers shall include, but not to be limited to, the
following:
• The applicant shall complete an application for affiliation. The application shall include a work history
covering at least five years and a statement by the applicant regarding any limitations in ability to perform
the functions of the position, history of loss of license and /or felony convictions, and history of loss or
limitation of privileges or disciplinary activity. The application shall also include whether the physician will
accept new patients from Parkland KIDSfirst, Parkland CHIP Perinate or Parkland CHIP Perinate Newborn.
The following shall be verified from primary sources and included in the credentialing file:
• A current valid license to practice in the State of Texas. The primary source for verification shall be the
appropriate Texas State licensing agency or board.
• If applicable, clinical privileges in good standing at the hospital designated by the physician or dentist as the
primary network admitting facility.
• If not Board Certified, education and training, including evidence of graduation from the appropriate
professional school and completion of a residency or specialty training, if applicable. Primary source
verification shall be sought from the appropriate schools and training facilities. If the state licensing board
or agency verifies education and training with the physician or provider’s schools and facilities, evidence of
current State licensure shall also serve as primary source verification of education and training.
• If the physician states that he/she is board certified on the application, primary source verification can be
obtained from the American Board of Medical Specialties, the American Osteopathic Association, the
American Medical Association Master File, or from the specialty boards.
The following will also be included in the physician or individual provider’s credentialing file:
• Malpractice history from the National Practitioner Data Bank;
• Information on previous sanction activity by HHSC or CHIP;
• Copy of a valid Drug Enforcement Agency (DEA) and Department of Public Safety Controlled Substance
permit, if applicable;
• Evidence of current, adequate malpractice insurance meeting the HMO’s requirements; and,
• Information about sanctions or limitations on licensure from the applicable state licensing agency or board;
• Professional liability claims history.
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