Why Doesn’t Texas HHS Know Anything About Credentialing Dentists for Medicaid?

This seems like a silly question because surely the agency that pays billions of dollars to DMOs and MCOs and keeps the Medicaid show on the road in Texas should know something—and perhaps should know everything– about the credentialing of their Medicaid dentists in Texas.

You wouldn’t be blamed for thinking so. We did.

But after receiving complaints about the lengthy credentialing delays both with TMHP and DMOs, we started wondering what is involved in the credentialing process and what caused the delays in that process.

What is this mysterious process called “credentialing?”

Asked Texas HHS

We initially thought the best place to ask was Texas Health and Human Services.  After all, our last story on this issue was about attorney Jason Ray and his letter of complaint about credentialing delays sent to the Office of the Medical Director, Medicaid and CHIP Services at HHS.

So without naming names, we inquired there too. Believe it or not, the response was that they didn’t know anything about credentialing and didn’t know anyone in HHS that oversaw that process.

This is the verbatim response when asked if there was someone we could speak to about credentialing at HHS – “I am sorry. I don’t know of anyone at this point in time. But please look at: Provider Enrollment | TMHP. Maybe you could call that number to contact TMHP… ”

Maybe now we see why Mr. Ray did not receive a response to his letter and why the credentialing delays of dental providers do not resolve. There seems to be no accountability or oversight by HHS – TMHP of the DMOs, which may mean the DMOs only answer to themselves.

Asked TMHP

We did take their advice, however, and called the TMHP Contact Center at 800-925-9126 and spoke to a very efficient and polite provider relations support person.

She said credentialing applications take varying amounts of time to approve depending on the application – a usual noncommittal response.

As the credentialing of emergency or substitute dentists for a practice location not already approved was our concern, we tried to pin her down. Eventually, she said under ideal circumstances it should only take a week to get a dentist credentialed for a new location if he is already credentialed at others in the same practice. If things were taking longer, TMHP provider relations support welcomed phone calls to resolve outstanding issues with an application to get it approved.  This seemed good news.

We then asked about the credentialing process — what was involved, what steps were done to credential someone, and where were the delays? She didn’t know.  That was another special department somewhere.  Did she have a phone number or a contact we could speak with?  No.  Was there a TMHP public relations person we could speak to? She didn’t know.  Ah well.

Asked Verisys

So we tried our luck with the agency Texas DMOs and MCOs use as part of the Texas Credentialing Alliance — Verisys.  It used to be Aperture Credentialing LLC. but Verisys and Aperture Health merged in 2021.

Like for TMHP we found a phone number for Verisys and gave them a call.  Fortuitously we reached an individual involved in the credentialing process for Texas DMOs.  In fact, he provided contact numbers for DentaQuest, MCNA and United Healthcare Dental.

The individual was quite helpful and forthcoming.

When asked about the process, he said the longest delays came from the DMOs not forwarding the applications in a timely manner.  He said their part of the credentialing process was the verification of the applicant’s information and this might take two to three months.

We were stunned by the answer and he immediately realized this. So he hedged that maybe it would only take a month or so.

This begs the question.  Why would a DMO require one month—much less two or three months—to review and approve an application for a provider that is already MCNA credentialed at another location?  If the provider is good enough to be in MCNA’s network in one city, why would MCNA need a full month to approve the provider to treat patients at a different clinic nearby?

Ouch. It seems there are no performance standards for this verification process. And that is another reason for the length of time for an application to be credentialed by a DMO.

Asked MCNA, MCNA didn’t call back

Then there is the question of what else a DMO does with a credentialing application.

Out of sheer interest, we reached out to MCNA via the number we were provided by Verisys.  The MCNA support person was congenial and friendly.  But they didn’t feel they could answer our questions and assured us that someone would phone back.

Of course, no one from MCNA did.

Credentialing process has no oversight, no standards

But there you have it.

The credentialing process is slow because no one pushes it to be fast. There is no oversight or standards set by Texas HHS.  TMHP and DMOs apparently only answer to themselves.  That’s bad news.

Providers and patients pay the price.

2 Responses

  • We are not dentists but APRN’s and have been involved with the Texas Medicaid program since 1990. When 1993 rolled around, APRN’s were allowed to enroll as Individuals. One and half page application as I recall. We were approved before the end of October.
    Many years later (maybe 15), we wanted to reinstate our FPC (family planning clinic – we have always been non-abortive) and that was 24 months to the week since the date of the submission of the application to TMHP.
    In the credentialing / recredentialing process, we have been informed that all have to verify to the original source all of the information on the application. Letters have to go the medical school for example. You have to send them a copy of the Nurses license even though it is on the license that it is not legal to copy same. We used to print a copy from the TBON once that became website became available.
    There is also the secret of the “expidition date”. There is a date, and once it was mentioned it really sped things up with regards to applications, that is 30 days after TMHP acknowledges receipt of an application we could call and ask for our application to be expidited. It was the addition of the requirement that all providers would have to go through a criminal background check that really began to add the time to these applications. Usually about three days later after we would make the call and ask for our application to be expidited we would receive a letter in the mail of the acceptance of our application and that new provider would then be enrolled.
    After 2004, when the MCO’s were added to the mix, then after approval by TMHP one would be able to submit to the MCO and the MCO would then go through the same original source vetting on all information on their application.
    The people that the enrollee cannot contact at TMHP is the actual person that is performing the credentialing. They will note the hours of operation that one will supply on the application and then always call either during lunch or just after you turn off the phones for the day so they only have to leave a message. To try to get in touch with them you used to have to fax a letter requesting a date and time to take a call.
    The credentialing people also do not seem to follow the same rules. Let one quit just prior to you getting your application approved and the new person will start over at the beginning with a different set of requirements.
    The TMHP Manual used to state that if you completed a PIF 1 (Provider Information Form 1) that you will NOT complete PIF 2 (Provider Information Form 2) but that does not stop the credentialing person from requiring you to submit both documents. They will let your application terminate if you do not comply.
    And imagine trying to have this sort of communication via written letters. Almost thirty days would elapse for each turn around on each issue that we had to resolve. That is how an application can take up to two years to get done.
    I agree that there are “no rules” as we have been searching for someone at any level of the State to see that the MCO’s follow the rules. This also includes the Presumptive Eligibility program. We use the PE program to begin to offer prental care to patients that just tested positive on their pregnancy test. The State does not follow the federal rules here either.
    I could go on ad infinitum about the Texas Medicaid program but I am straying a bit from the topic of credentialing and how there does not seem to be either any rules or no one to enforce those rules.

  • Most states delegate the credentialing process to MCOs. MCOs make their $$$ off of per capita utilization, not credentialing or oversight. So guess what is the result?

    Credentialing is devalued.

    Michael W Davis, DDS
    Santa Fe, NM

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