Provider Resources

Resources for AultCare Network Providers

AultCare values the relationships we have with our network providers. As healthcare continues to evolve, we recognize the many challenges doctors face, and aim to be a resource for your practices. We strive to maintain a high level of service with our claim turnaround time being one of the best in the industry. Our claims are processed accurately and our representatives are knowledgeable and accessible.

We provide you with many tools to assist in working with AultCare. If you need further assistance, please use the contact button below or call us locally at 330-363-6360 or toll-free at 1-800-344-8858 Monday through Friday from 7:30 am to 5:00 pm. We look forward to working with you!

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Appeals & External Review

  • Internal Appeal Request Form - If you disagree with a determination decision about a specific benefit, you have the right to file an internal appeal with AultCare using this form. You may also submit your appeal in writing and include any written comments, documentation, or records relevant to your appeal.
  • AultCare Treating Physician Certification for Experimental or Investigational ABD - You may have your provider complete this form if your request for benefit determination has been denied as Experimental or Investigational. (We do not require the completion of this form, but provide it for your convenience. Your provider must certify to us in writing that your request is of an expedited nature before we will proceed with it as an expedited appeal.)
  • AultCare Treating Physician Certification for Internal Appeal and/or External Review - You may have your provider complete this form if your request for benefit determination has been denied and you are requesting an expedited appeal or review. (We do not require the completion of this form, but provide it for your convenience. Your provider must certify to us in writing that your request is of an expedited nature before we will proceed with it as an expedited appeal).
  • External Review Request Form - If you disagree with our appeal decision and have exhausted your internal appeal rights, you can request an External Review using this form. (For Insured and Public Employer Plans Only)
  • AultCare Request for Review by the Ohio Department of Insurance - If we have denied your request for an External Review and you disagree with our decision, please use this form.
  • External Review Procedures Summary - An explanation of the External Review procedure for all Insured and Public Employer Plans effective 02/2012.

Guides, Forms, & Directives

HIPAA Forms

  • HIPAA Access Request form — Members can use this form to access their insurance Protected Health Information (PHI) from AultCare. Please route this request to the Privacy Coordinator at AultCare. Please allow a 15 day turnaround response time for this request.
  • HIPAA Amendment Request Form — Members can use this form to request a change to the Protected Health Information (PHI) AultCare has on file. This can be used if the member has found an error in their PHI.
  • HIPAA Confidential Communication Request Form — Members can use this form to request that their Explanation of Benefits (EOB) or other AultCare communications are confidentially sent to a different address than what is on file or that phone calls are made to a different phone number. If you feel that harm may be caused if your information is sent to anyone outside of you, please complete the Member Request to Restrict Uses and Disclosures form.
  • HIPAA Designation of Authorized Representative Form — Members can use this form to designate someone other than you to speak to us on your behalf. Legal documentation (such as a General or Durable Power of Attorney or Guardianship) is required to allow an Authorized Representative to make actual changes on your behalf.
  • HIPAA Member Restrict Uses and Disclosures — Members can use this form to limit who has access to their Protected Health Information (PHI).
  • HIPAA-Electronic Transactions

Credentialing Information

CREDENTIALING FORM: Provider Information Update Form

CREDENTIALING 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.

Ohio Standardized Credentialing Form

  • This form is used both for the Credentialing and Re-credentialing process, once approved for an application.
  • Ohio organizations are required to use the state-mandated credentialing form developed by the Ohio Department of Insurance.

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.
  • The CAQH Website, www.CAQH.org, provides instructions for accessing the system. You can also reach them by: Help Desk Phone: 888.599.1771 Help Desk E-mail: caqh.updhelp@acsgs.com

Communicating Changes in Provider Status

Please complete our provider information form.

Examples in changes in Provider Status:

  • Provider Retirement
  • Practice affiliation change
  • Leave of absence
  • Practice Name change
  • Practice Location change
  • Tax Identification Number change
  • Billing Information change
  • Location closing
  • New Location

AultCare Re-Credentialing Process

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

Who Do I Call For...

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 Provider Credentialing at 330-363-1400.

OSHA

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 available by clicking on: OSHA Offices> Regional and Area Office Map > OSHA Region 5.
  • Information on the new recordkeeping forms that came into use on January 1, 2002 is available under Regulations > Frequently Asked Questions >Recordkeeping.

HIPAA Source

  • 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