3901-1-58 Standard credentialing form for physician and non-physician providers.

(A) Purpose

The purpose of this rule is to prescribe the standard credentialing form to be used when credentialing or recredentialing providers. For purposes of this rule, the term "providers" shall have the same meaning as in division (P) of section 3963.01 of the Revised Code.

(B) Authority

This rule is issued pursuant to the authority vested in the superintendent under sections 3901.041 , 3901.21 , and 3963.08 of the Revised Code.

(C) Form

All credentialing and recredentialing of physicians and non-physician individual providers identified in division (P) of section 3963.01 of the Revised Code shall be performed using the credentialing form available from the council for affordable quality healthcare (CAQH) in electronic or paper format. The CAQH credentialing form shall be referred to as the department of insurance part A credentialing form. Copies of this form may be obtained electronically from CAQH or from the department of insurance. The department of insurance part B credentialing form shall be used to credential hearing aid dealers, home health agencies, hospice care providers and all other providers, with the exception of hospitals, that are not individuals. Copies of this form may be obtained from the department of insurance. The credentialing forms prescribed by this rule may be reproduced as needed and may be amended from time to time.

(D) Severability

If any provision of this rule or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the rule and the application of such provision to other persons or circumstances shall not be affected thereby.

R.C. 119.032 review dates: 01/08/2014 and 08/31/2018
Promulgated Under: 119.03
Statutory Authority: 3901.041 , 3901.21 , 3963.08 , 1753.09
Rule Amplifies: 3901.20 , 3901.21 , 3963.05 , 3963.06
Prior Effective Dates: 1/14/1999, 1/14/2002, 5/30/2009