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
• 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: firstname.lastname@example.org 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 LocationAultCare 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