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Ohio Standardized Credentializing Form: |
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The form is used both for the Credentialing and Re-credentialing process.
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Revisions of the standardized credentialing form have been finalized.
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CAQH Information:
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The system is a national provider credentialing application initiative from the Council for Affordable Quality Healthcare.
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The streamlined database is the single repository of participating health plans for healthcare provider information, alleviating the need for physicians and other healthcare providers to complete and submit many and varied credentialing forms for multiple health plans, hospitals and other healthcare organizations.
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There are no fees to physicians and other healthcare providers to use the database.
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The CAQH Website, www.CAQH.org, provides instructions for accessing the system. You can also reach them by calling (202)861-1492.
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Communicating Changes in Provider Status:
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Examples are:
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Provider Retirement
Practice affiliation
Leave of absence
Practice Name
Practice Location
Tax identification
Billing Information
Closing your office (whether permanent or temporary; will need start & stop dates please).
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Use the Provider Information Update Form to communicate any of the above changes.
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Fax or mail to the Credentialing Department:
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Fax (330) 363-6421
Address: Po Box 6910, Canton, Ohio 44706-0910
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AultCare Re-Credentialing Process:
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Re-credentialing packets are mailed to providers approximately one year prior to their re-credentialing due date.
Please be sure to provide the following information:
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Original signatures on the Affirmation of Information page (Attestation) and the AultCare Addendum page.
Work History for the past five years. Include ALL practice locations
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Please provide complete explanations when:
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You answer "Yes" to any of the questions located in Section XIII, Professional Claims Dept. of the Ohio Standardized Credentialing Form.
You answer "No" to question #19 in Section XIII.
You report a "positive malpractice claims history" in Section XII; Malpractice claims History, of the Ohio Standardized Credentialing Form.
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Who Do I Call For...
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When questions or concerns arise regarding billing/claims and provider related issues, please contact the AultCare Service Center first. They can be reached at: (330) 363-6360 or (800) 344-8858.
If your issue cannot be resolved, your call may be routed to the Provider Relations Department, which is staffed by:
Provider Relations Representatives: call 330-363-1160
They can help educate provider office staff on issues regarding AultCare communications, policies and procedures, and billing/claims related issues.
For questions related to credentialing/recredentialing, requests for application, and provider status changes, please contact Quality and Provider Credentialing at 330-363-1400.
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OSHA:
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Do you have questions about OSHA standards for your office? There is information available on the internet from the sites listed below:
The general website is: www.osha.gov
From there you can view training materials by clicking on Programs and Services and then on Training Materials to receive information on the new Tuberculosis regulations
Ohio phone numbers and addresses are availble by clicking on OSHA Offices, Regional and Area Office Map, and choosing OSHA Region 5.
Information on the new recordkeeping forms that came into use on January 1, 2002 is available under Regulations, Frequently Asked Questions, and clicking on Recordkeeping.
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HIPAA Source:
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For fact sheets, immediate releases and newsletters, go to www.hhs.gov
Answers to common questions about the new protections for consumers and requirements for doctors, hospital, other providers health plans and health insurers, and health care clearing houses go to www.hhs.gov/ocr/index.html
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