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6. The completed Office Site Evaluation Form will be placed in the practitioner’s Credentialing file
prior to review by the PACC.
Member Complaint or Quality of Care Concern
1. In response to a Member complaint and/or Quality Improvement office site or a quality of care
concern relating to office site issues, Provider Relations staff shall conduct an office site review
using the same Office Site Evaluation Form and procedures as at initial credentialing or a different
data tool depending on the substance of the complaint.
2. Results of office site review will be evaluated, along with the complaint or quality of care concern,
by the Provider Advisory Credentialing, Committee.
PROVIDER RE-CREDENTIALING
All Participating Providers must adhere to the re-credentialing requirements established by Bravo Health.
The standard states that Providers must be formally re-credentialed every three (3) years. It is imperative
that Providers complete the re-credentialing process in order remain in good standing and continue to treat
Bravo Health Members. Non-compliance with the re-credentialing process in advance of the Provider’s due
date for re-credentialing will result in termination from the Bravo Health Provider network.
PRACTITIONER’S RIGHTS
The practitioner has the right to review information submitted to Bravo Health in support of his or her
credentialing/re-credentialing application except for peer review information that is confidential, protected
and restricted under State and Federal Peer Review Laws.
The practitioner will be notified in the event that information obtained from other sources varies
substantially from that provided by the physician and he or she will be given the opportunity to clarify
and/or correct this information prior to the finalization of the credentialing/re-credentialing process.
The practitioner has the right, upon request, to be informed of the status of their credentialing or re-
credentialing application. The practitioner can contact their Provider Recruiter or the Bravo Health
Credentialing Department at 866-442-7499 to make such a request.
Bravo Health Texas, Inc. conducts its credentialing and re-credentialing processes in a non-discriminatory
manner and does not base its decisions for applicant participation solely on an applicant’s race,
ethnic/national identity, gender, age, and sexual orientation or the types of procedures or types of patients
the practitioner specializes in. All decisions are based in the aforementioned criteria.
Bravo Health Texas, Inc., upon written request from a health care Provider that is applying to be
credentialed or a physician who is already credentialed, shall disclose the relevant credentialing criteria
outlined above.
Bravo Health Texas, Inc. will not exclude from credentialing or terminate a health care Provider who has a
practice that includes a substantial number of patients with expensive medical conditions.
