Verified October 10, 2026 against the statutes, regulations and sources cited below. General information, not legal advice. All states
What providers miss in Texas
- Texas HMOs must open a 20-day application window every year, and the 90-day answer rule is tied to that window, so its timing matters.
- The advisory review panel is only advisory: the insurer may decide against its recommendation, but must explain that decision in writing on request.
- Medicaid expedited credentialing for therapists and counselors requires joining a group or FQHC that already holds a Medicaid MCO contract, and Medicaid enrollment first.
Does Texas have an any willing provider law?
Insurers with preferred provider (PPO and EPO) plans must give licensed providers a fair, reasonable and equivalent opportunity to apply and may not unreasonably withhold designation. They may still reject an applicant when the plan has sufficient qualified providers. HMOs are not covered.
- Limited any willing provider law
Citation: Tex. Ins. Code 1301.051
How long can a plan take to credential a provider in Texas?
HMOs must answer physician and provider applications within 90 days during the annual application period. Medicaid MCOs must finish credentialing and load the provider within 90 calendar days of a complete application and list missing items within five business days.
- Deadline: 90 days
- Applies to: HMOs during their annual application period; Medicaid managed care organizations by contract
Citation: 28 Tex. Admin. Code 11.1402(c); HHSC Medicaid managed care contract
Can a provider practice in network while Texas plans credential them?
A physician joining a medical group, medical school or teaching hospital already in an HMO or PPO network is paid as in network while expedited credentialing runs. Medicaid MCOs must also credential certain dentists, therapists, counselors, social workers, psychologists and FQHC providers on a provisional basis.
- Provisional or interim credentialing
Citation: Tex. Ins. Code 1452.103-.104; Tex. Gov't Code 540.0656
What network adequacy rules apply in Texas?
Preferred provider plans must meet TDI network adequacy standards on time, distance and appointment availability, report a material deviation within 30 days and fix it within 90 days. A waiver lasts at most one year and needs good cause shown at a public hearing.
Citation: Tex. Ins. Code 1301.0055; 1301.00565
PPO fair opportunity law
A PPO insurer must give written reasons when it denies an initial application, offer review by an advisory panel of at least three participating practitioners including one in the same or similar specialty, and on request share the panel's recommendation and explain in writing any decision against it.
Citation: Tex. Ins. Code 1301.051-.054
HMO annual application period
HMOs must hold a 20-day application period each year when physicians and providers may apply to each network, and must accept or decline each application in writing within 90 days.
Citation: Tex. Ins. Code 843.305; 28 Tex. Admin. Code 11.1402
Annual notice of the chance to participate
Each year a PPO insurer must notify nonparticipating practitioners in its service area of the opportunity to apply, and on request explain its application process and qualifications.
Citation: Tex. Ins. Code 1301.054
Network adequacy waiver hearings
Before granting certain waivers, the commissioner holds a public hearing and must notify affected physicians and providers, who may submit evidence and written testimony and testify in person or virtually. The hearing weighs whether the insurer made a good faith effort to contract with available providers.
Citation: Tex. Ins. Code 1301.00565
Will the Texas insurance department take a provider complaint?
- Texas Department of Insurance
Who oversees Medicaid managed care plans in Texas?
- Texas Health and Human Services Commission
Turned down by a plan in Texas?
We read the denial, check which of these rules reach that plan, and prepare the reconsideration request, the access-gap evidence and any regulator complaint the law supports; you sign and send them, and we track every deadline. Self-funded employer plans follow federal law, not Texas's. A rejection review is $249, credited toward a dispute.
Sources
- anyWillingProvider, extras (fair opportunity, written reasons, sufficient providers)
- extras (advisory review panel)
- extras (annual notice)
- networkAdequacy (standards, 30 and 90 days, one-year waivers)
- extras (waiver hearings, provider notice and testimony)
- credentialingDeadline (HMO 90 days), extras (20-day annual application period)
- provisionalCredentialing (physician eligibility)
- provisionalCredentialing (paid as participating)
- provisionalCredentialing (Medicaid expedited credentialing)
- credentialingDeadline (28 TAC 11.1402(c); Medicaid 90 days and five business days), provisionalCredentialing (Medicaid provider types)
- insuranceDept, notes (share of market TDI regulates)