Resources for AultCare Network Providers

• Physician & Hospital Information Validation — This document is a guide to understanding terminology within the provider directory.
• Provider Directories
• Primary Care Communication Form — Complete form for communication between the Primary Care Physician and the referred Behavioral Health Provider.
• Surprise Billing Model Notice — Explanation of your rights and protections against surprise medical bills.
• Care Coordination/Population Health Management Programs- Help Your Patients Stay Healthy and manage Chronic or Acute Conditions
• Access to UM Staff and Appropriate UM Decision Making
• Website Information

• Home Healthcare Services Form
• Molecular Diagnostic Request Form
• Pre-Authorization & Referral Form- Use this form for medical procedure requests. Please do not fill out this form for pharmacy medications.

AultCare currently offers two forms of payment for claims to providers: paper check or electronic funds transfer (EFT). We do not apply fees for issuing payments to providers.

Providers may switch between the two methods by contacting our Service Center. There is no fee to switch. We can be reached locally at 330-363-6360 or toll-free at 1-800-344-8858 Monday through Friday from 7:30 a.m. to 5 p.m.

HIPAA 835 Transactions:  Electronic Funds Transfer (EFT)/Electronic Remittance Advice (ERA)

For providers who are NOT currently receiving EFT/ERA transactions:

Please complete the EFT/ERA Enrollment Form (login required) to implement the 835 EFT/ERA process.

• Once logged in to the Provider Portal, click on the Important Forms tab at the top of the landing page.
• Click on the EFT/ERA Enrollment Form link.

After the enrollment form is submitted, our EDI Department will contact you to begin testing.

• Once testing is complete, a “go live” date will be established.
• Claims processed after the established "go live" date will begin generating through the 835 remit process.
• You will continue to receive paper checks for runout claims processed prior to the "go live" date.

Current 835 providers:

1. If you are adding a new location for your practice, and payments are to be directed to your current billing/pay to address, you are not required to complete the online 835 EFT/ERA Enrollment Form.
   
   
2. When a new location is added and payments are to be directed to a different billing/pay to address, you will be required to complete the online 835 EFT/ERA Enrollment Form for appropriate setup.
   
   Once we receive the completed 835 EFT/ERA Enrollment Form, our EDI Support Department will work with you on testing and establishing a "go live" date. In the interim, if claims are received for the additional location, paper checks will be generated until the testing and "go live" date are finalized.

If you have any questions, please contact the EDI Support Department at edisupport@aultcare.com.

• HIPAA-Electronic Transactions — Use this page for electronic payments. 

Request to Become a Provider and Update Provider Information

Thank you for your interest in becoming a network provider. Please complete and submit the Provider Information Form or the Facility Information Form as a request for an application. Your request will go before our committee and you will be notified in writing of our committee’s decision. AultCare’s receipt of your provider information form does not guarantee participation in our networks.

• Provider Information Form — Use this form to request to become a provider or to update your provider information.
• Updating Provider Information Guide
• Facility Information Form  — to facilitate the credentialing process.

CAQH Information

The system is a national provider credentialing application initiative from the Council for Affordable Quality Healthcare. 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. There are no fees to physicians and other healthcare providers to use the database. Visit caqh.org for instructions to access the system. You may also contact them at 1-888-599-1771 or at caqh.updhelp@acsgs.com.

Please remember to keep your CAQH account updated and re-attested too.

Contact Information

Provider Credentialing, Networks, Credentialing, & Contracting

330-363-1400

Fax: 330-363-6421

credentialing@aultcare.com