MaternOhio Credentialing Program

Services Rendered by MaternOhio

• Credentialing Data Warehouse
• Forms Printing and Submission
• Tracking of Submitted Applications
• Notification of Expiring Certificates
• Medicare & Medicaid Application Submission
• Annual Updates to each Physician's Information
• Request for Credentialing Submission from Practices
• Submission of Credentialing for MaternOhio Negotiated Carrier Contracts
• Annual Cost is $1000 per Physician

Credentialing Data Warehouse

MaternOhio's Credentialing Department offers information maintenance for your practice and provider information. Any attachments needed-such as state board licenses, DEA certificates, malpractice face sheets, etc.-will be kept on file, so that they can be attached to the physician's file and printed as needed.

Forms Printing, Submission and Tracking

MaternOhio can complete any insurance application within seconds and have it prepared to mail to the carrier within minutes. Once printed, we will track the mailing date of all paperwork being mailed to the carrier for credentialing, or if necessary to the practice for signature. MaternOhio will maintain a signature on file for each physician verifying that the information on file for each physician is accurate.

Tracking of Submitted applications

All insurance carriers will receive follow-up notices to track the re-credentialing information in the following methods:

•  All carriers that MaternOhio maintains a contract with, Credentialing will begin to follow up with the carrier within 90 days and every month thereafter to ensure that the information is processed.

•  Every new contract between a carrier and physicians will be followed-up on within 90 days, and every month thereafter to ensure the information is processed.

•  All carriers where physicians where physicians have a long standing relationship, will be handled on an as-needed basis. Unless the practice specifically requests tracking of the credentialing process, then Credentialing will only submit the information.

 

Notification of Expiring Certificates

MaternOhio will track the effective and expiration dates for all documents that require periodic renewal. 90 days before the expiration on any medical information, MaternOhio will notify the practice to begin the process of renewing the document. Some of the documents that will be tracked for renewal include the following:

• State Medical Board Certificate
• Drug Enforcement Administration Certificate
• CPR Certificate(s)
• Board Certification
• CLIA Certificate(s)
• Etc.

Medicare and Medicaid Application Submission

As needed, MaternOhio will submit to either Medicare or Medicaid paperwork as requested by participating practices. A clear request is required, and MaternOhio will make contact with the requesting practice to confirm their intent. Once any paperwork is created, it will be mailed to the practice for verification and signature by the physician(s) affected.

Annual Updates to Practice and Physician Information

Annually, MaternOhio will print out all the data that is held in the MaternOhio Credentialing Database, and submit it to the physician/office manager for review and correction. As this step helps to ensure that the information maintained and subsequently submitted to carriers is accurate, the physician must sign these documents to confirm to MaternOhio that the data contained therein is accurate and that the physician authorizes MaternOhio to submit it on their behalf, as directed by the practice.

Request for Credentialing Submission from Practices

The following is the credentialing process that will occur for participating practices:

1. Practice information is submitted to MaternOhio and is loaded into the MaternOhio Credentialing Database;
2. Practice submits to MaternOhio by email, fax or mail any request for credentialing information;
3. MaternOhio submits a confirmation notice to the practice of the requested information;
4. MaternOhio produces the required documents (ODI, W-9, Medicare or Medicaid Forms);
5. MaternOhio determines the necessary step for signature:
1. ODI forms - Attach the appropriate consent and release form that has been pre-signed by the physician;
2. Medicare & Medicaid forms - Submit to the practice for signature by the physician;
3. W-9 form - MaternOhio signs on behalf of the practice, then faxes or mails directly to the carrier;
6. MaternOhio tracks the submission and follows up in 1 week if sent to the practice;
7. Each provider's information will be updated as needed, and at least annually.

Submission of Credentialing for MaternOhio Negotiated Carrier Contracts

From time to time, MaternOhio will negotiate or renegotiate an insurance contract with a carrier where practices are required to re-submit all of their credentialing information. All practices who participate in the MaternOhio Credentialing Program will only need to notify MaternOhio that they want to participate in the carrier contract. Once received, MaternOhio will submit their credentialing information to the carrier.

Annual Cost is $1000 per Physician