Who needs an LHL234 Form?
Form LHL234 is the Texas Standardized Credentialing Application should be filed in order to match all the requirements of Senate Bill 544 as the standard form of verification of physician credentials. As you can see now, this form is to be filed by medical facilities (such as the hospitals, HMO's and PPO's) who need this kind of legal validation for their physicians in the State of Texas.
What is LHL234 Form for?
Average medical facility can use this application form for credentialing of physicians, as well as for the credentialing of other health care professionals. Information provided on this form gives a summary of qualifications and work history that is used in such credentialing process.
Is LHL234 Form accompanied by other forms?
A person which is to be applied for the credentialing must provide all necessary documents in support of their qualification, education and certification. All the necessary documents to be attached are specified in the appropriate parts of this form.
How do I fill out LHL234 Form?
In general, the following information should be provided in order to complete the form:
-
Applicant’s personal information;
-
Primary or Pending Practice Location;
-
Billing Information;
-
Education;
-
Residency/Postgraduate/Professional Training;
-
Employment History;
-
Specialty/Subspecialty Certification;
-
Drug Enforcement Administration Registration;
-
Liability Insurance;
-
Professional/Peer References;
-
Life Support Certification;
The Disclosure Questionnaire for Initial Credentialing is to be answered as well.
The last step in completing the form is signing out the Notice of Applicant’s Rights and Attestation.
The Application Attestation Update block must be signed only if a previous completed application is being reviewed and updated.
Present and past affiliations beginning with most recent.
If more space is needed than provided on the application, please attach additional sheets and reference the questions being answered. You should mark all non-applicable sections with N/A. Do not use abbreviations when completing the application.
Where do I send LHL234 Form?
This form should be sent to the carrier with whom a physician wishes to become credentialed.
