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

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

• 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.

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