Physicians interested in participating in the managed care contracts offered by Genesis Physicians Group
must first become members of Genesis Physicians Group. To be a member of GPG, please complete the following
information and send it to us.
- Complete GPG Membership Application by selecting the appropriate form below.
- Send appropriate membership fee outlined in the three forms (PCP, SCP, BH).
- Complete the Credentialing Application (revised 2007).
- Include copies of appropriate supporting documentation to the Credentialing application.
- DEA
- DPS
- Certificate of Insurance
- Texas State License
- Completed work history
- Completed malpractice history with details of cases
- Completed W-9 form
- Signed GPG Participation Agreement.
Upon approval by the GPG Membership Committee, applicant is presented to the GPG Peer Review Committee for
credentialing. Upon approval by the Peer Review Committee, you will be given an opportunity to select GPG
offered payor contracts you wish to participate in, referred to as the Opt In/Opt Out packet.
Timeline:
Membership and Credentialing process, beginning with the receipt of complete application packet as described
above takes approximately 30 days.
Physician is submitted to managed care payors within one week of receipt of completed Opt in, Opt Out packet from the physician.
Obtaining effective dates varies among the managed care payors. However, physicians usually receive effective dates for the
selected payors in approximately 60 days from submission of application by GPG.