Texas Department of Insurance Forms

This form is used for the Texas Standardized Credentialing Application and specifically focuses on the applicant's history of malpractice claims in the state of Texas.

This type of document is a form used for disclosing other current hospital affiliations in Texas as part of the Texas Standardized Credentialing Application.

This form is used for adding additional information to a Biographical Affidavit in the state of Texas.

This form is used for the Preferred Provider Benefit Plan (PPBP) and Exclusive Provider Benefit Plan (EPBP) in Texas. It includes an annual report, waiver request, and access plan checklist.

This form is used for Workers' Compensation Health Care Network Access Plan Checklist in the state of Texas.

This form is used for holders of bonds or notes over $100,000 in the state of Texas to report their holdings.

This form is used for checking the HMO delegation agreement in Texas.

This document is a checklist for the contract requirements of a Workers' Compensation Network Contract with an insurance carrier in Texas. It ensures all necessary elements are included in the contract.

This form is used for providing information about previous hospital affiliations in Texas when applying for standardized credentialing.

This Form is used for identifying the designated contact for utilization review requests in Texas.

This Form is used for certifying the independence and qualifications of the reviewer in the state of Texas.

This form is used for documenting the daily inspection record of amusement rides in Texas, in accordance with the Amusement Ride Safety Inspection and Insurance Act.

This Form is used for providing other work history details in the Texas Standardized Credentialing Application in Texas.

This form is used for Health Maintenance Organization (HMO) network access plan requirements in the state of Texas.

This form is used for certifying the repair of water damage caused by an appliance in the state of Texas.

This Form is used for the qualification review of Field Safety Representatives with a specialty in hospitals in the state of Texas.

This form is used for reviewing the contract checklist for managing health care networks in Workers' Compensation cases in Texas.