Genesis Physicians group credentialing and health plan enrollment journey

Steps in Your Credentialing Process & Timelines

Credential Verification

Your credentials will be verified in line with NCQA, CMS, Texas Department of Insurance, and relevant Health Plan standards.

Peer Review

The Genesis Credentialing team will submit your profile to the Genesis Physicians Group Peer Review Committee for a formal review and approval process.

Timeline

The credentialing phase typically takes 4-6 weeks, marking roughly 25% of the overall process to secure your HealthPlan effective dates.

Enrollment

Our Enrollment team will then actively engage with Health Plans to finalize your effective dates during the subsequent phase which could take up to 145 days.

Ongoing Required Reporting

Weekly ReportsMonthly Report
1. Aetna2. Humana*1. Care N Care
3. BCBS4. IMS2. Coalition
5. Cigna6. Majoris3. Healthcare Highways
7. Coastal8. Multiplan4. Parkland
9. Galaxy10. UHC5. Superior
11. HeathEZ12. USA6. Wellpoint
13. HealthSmart14. WellCare

*Humana exited the Commercial market effective 1/1/2025.  

  1. Membership Transition: Current members will remain covered until their plan expires.
  2. Provider Agreement: Providers will continue to care for members until all members are fully transitioned. 
  3. Medicare Plans: This change does NOT impact Medicare plans, which will continue to be offered.  

If you are currently enrolled in the commercial PPO plan, you will remain a participating provider and continue caring for enrolled members until the membership ends. No action is required on your part at this time. 

Required Ongoing Monitoring done by Genesis Physicians Group

Ongoing verification

This is essential to stay compliant with regulatory requirements and health plan policies. These are completed monthly at the end of each month.

TMB and NPDB

Credentialing is notified via email when new reports have been filed or settled. We will reach out to the practitioner for a statement and any additional information or documentation to present to Peer.

  1. CMS Preclusion List: exclusion list of individuals that are prohibited from participating in federal healthcare programs.
  2. Complaint Log – Issues, Practitioners, Clients and/or Payor Complaints 
  3. CMS – Medicare Opt Out: provider chooses not to participate in Medicare.
  4. NPDB (National Practitioner Data Bank): tracks disciplinary actions
  5. OIG (Office of Inspector General)
  6. TX OIG (Texas Office of Inspector General)
  7. SAM (System for Award Management)
  8. TMB (Texas Medical Board)
  9. TDI (Texas Department of Insurance)

Ongoing Credentialing Cycle

Your credentials will be reverified every 3 years.
    • In between re-credentialing cycles, Genesis team conducts ongoing monitoring as per NCQA, CMS, and HealthPlan guidelines to maintain your HealthPlan enrollment and ensure there are no disruptions in your revenue cycle.
    • It’s essential to continue keeping your CAQH profile current.
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