Genesis Physicians group credentialing and health plan enrollment journey

Steps in Your Credentialing Process & Timelines

      1. Credential Verification: Your credentials will be verified in line with NCQA, CMS, Texas Department of Insurance, and relevant Health Plan standards.
      2. 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.
      3. Timeline: The credentialing phase typically takes 4-6 weeks, marking roughly 25% of the overall process to secure your HealthPlan effective dates.
      4. 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

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. 
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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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1)  Login into CAQH to update and attest your Provider Profile. Please utilize the below checklist to upload the necessary information into your CAQH profile: 
      • Updated practice information:
        • Please ensure that your practice information is up-to-date and accurately listed on your CAQH profile. GPG will import practice locations directly from CAQH, so it is essential to verify that all practice locations are correctly listed to avoid any discrepancies and delays in your credentialing process. 
      • Copy of current Texas State Medical License
      • Copy of current Texas DEA Certificate
      • Copy of current Certificate of Malpractice Insurance (minimum $200,000 per occurrence/$600,000 in the aggregate)
      • Board Certification (if applicable): must be Board certified or Board eligible
      • Hospital Affiliations(if applicable): must have active hospital privileges, temporary privileges do not fulfill the requirement
2)  Submit Payment and initiate the 1-Minute Application process.
3)  Please use the links below to download, sign and send the following documents back to credentialing@genesisdocs.org.
4)  Opt-in Health Plans of your choice to start the Enrollment process after Peer Review Committee approval.

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