Provider Credentialing

All physicians in the IntegraNet network are required to complete our credentialing process. For all new providers, the following documentation is needed:

• Texas Standardized Application, including signature and dated attestation that allows your release for the accuracy of information provided (available on the Texas Department of Insurance website);
• Copy of Curriculum Vitae;
• Copy of your current Texas License;
• Copy of your current DEA (Federal drug permit);
• Copy of your current DPS (State drug permit);
• Copy of your current Malpractice Insurance;
• ECFMG Certificate (if applicable);
• Malpractice Claims History-Provide information for all cases occurring in the past 5 years;
• Copy of American Board Certificate (if applicable);
• CME (Continuing Medical Education) for the past three years;
• W-9 Form; and
• Sample HCFA 1500 Claim Form

The standardized application, along with the above-referenced documents, should be completed in its entirety and submitted to Rebecca McAnally, our Director of Credentialing, via the following methods: