Credentialing
In addition to completing your credentialing application with CAQH, you will need to complete the OSCIPA Provider Agreement and checklist located in the JOIN OSCIPA section. Select the JOIN OSCIPA tab and initiate the OSCIPA membership application process. Upon receiving credentialing information from CAQH, the OSCIPA documents in the JOIN OSCIPA section, and the $175 credentialing fee, your application will be submitted to our Credentialing Committee and Board of Directors for approval. Your application will not only be for OSCIPA membership, but will also be for our contracting carriers and networks as well.
Credentialing is the process by which OSCIPA reviews and validates the professional qualifications of physicians who apply for participation within our organization, ensuring that we meet the professional standards required by the insurance entities that we provide credentialing services for.
Effective May 1,2012 the Council for Affordable Quality Healthcare, Inc. (CAQH) will collect the data required for our credentialing and recredentialing process. CAQH uses a Universal Provider Datasource® (UPD) form to electronically collect the data. This online credentialing application process supports our administrative simplification and paper reduction efforts. This solution also supports quality initiatives and helps to ensure the accuracy and integrity of our provider database. Once that information is obtained by CAQH, then OSCIPA can begin our credentialing process with the insurance payors and networks that we provide credentialing services for. Providers may utilize the UPD at no cost, but there is a one-time OSCIPA credentialing fee of $175.
The Council for Affordable Quality Healthcare, Inc. (CAQH) is a not-for-profit collaborative alliance of the nation’s leading health plans and networks. The mission of CAQH is to improve health care access and quality for patients and reduce administrative requirements for physicians and other health care providers and their office staffs. CAQH is solely responsible for its products and services, including the Universal Provider Datasource.
OSCIPA has a Credentialing Coordinator that monitors all credentialing processes. All of our credentialing services meet standard credentialing criteria established by the National Committee for Quality Assurance (NCQA), American Accreditation Health Care Corporation (AAHCC), and the Joint Commission for Accreditation of Healthcare Organizations, (JCAHO). OSCIPA consistently passes annual credentialing audits by our contracted health plans and networks.
Click on the topics below to see more information.
In addition to completing your credentialing application with CAQH, you will need to complete the OSCIPA Provider Agreement and checklist located in the JOIN OSCIPA section. Select the JOIN OSCIPA tab and initiate the OSCIPA membership application process. Upon receiving credentialing information from CAQH, the OSCIPA documents in the JOIN OSCIPA section, and the $175 credentialing fee, your application will be submitted to our Credentialing Committee and Board of Directors for approval. Your application will not only be for OSCIPA membership, but will also be for our contracting carriers and networks as well.
- If you are not registered with CAQH and are a first-time user, when you apply for OSCIPA membership, we will add your name to our roster with CAQH. CAQH will mail you access and registration instructions, along with your personal CAQH Provider ID, allowing you to obtain immediate online access to the UPD.
- When you receive your CAQH Provider ID, go to the CAQH website to register. After validating key information, you will be able to create your own user name and unique password to begin using the UPD database.
- Once registration is completed, you may use your user name and password to log in at any time.
Completing the CAQH Application Process
The UPD standardized application is an online form that meets the needs of all participating health care organizations. When completing the application, you will indicate which participating health plans and health care organizations you authorize to access your application data. All provider data you submit through the UPD service is maintained by CAQH in a secure, state-of-the-art data center.
When you are ready to begin entering your data, log in to the UPD with your user name and password.
The following materials are helpful to reference while applying:
- Previously completed credentialing application
- List of previous and current practice locations
- Various identification numbers (UPIN, NPI, Medicare, Medicaid, etc.)
- State medical license(s)
- Curriculum Vitae
- IRS Form W-9(s)
- Malpractice insurance face sheet
- Summary of any pending or settled malpractice cases
After completing the application, you will also be asked to:
- Authorize access to your information – List the organizations that you would like to receive your information. You may select "OSCIPA" or "global authorization."
- Verify your data entry – Review a summary of your data for completeness and to make any changes as necessary.
- Submit supporting documents – To complete your application, fax the supporting documentation to CAQH at (866) 293-0414.
If you have any questions on accessing the UPD database, you may contact the CAQH Help Desk at (888) 599-1771 for assistance.
OSCIPA may need to supplement, clarify, or confirm certain responses on your application with you. Therefore, you may be required to provide us with supplemental documentation in some situations, in addition to the information you submit through the UPD. You will receive notification if any additional information is needed by OSCIPA.
Visit the CAQH website for more information about the UPD and the application process. You may also contact Elizabeth at OSCIPA with any questions regarding this new procedure.
- If you are already registered with CAQH through a health plan, log in to the UPD and add OSCIPA as one of the organizations that can access your information.
- Go to https://upd.caqh.org/OAS/, and enter your username and password.
- Click the "Authorize" tab located under the CAQH logo.
- Scroll down, locate OSCIPA, and check the box beside OSCIPA. You may also select "global authorization." If you have chosen "global authorization," then OSCIPA will already have access to your data.
- Click "Save" to submit your changes.
- Visit the CAQH website for more information about the UPD and the application process. You may also contact Elizabeth at OSCIPA with any questions regarding this new procedure.
CAQH requires you to review and attest to your data once every four months. At the time you are scheduled for recredentialing, OSCIPA will send your name to CAQH to determine if you have already completed the UPD credentialing process. If so, we will be able to obtain current information from the UPD database and complete the recredentialing process. The process of recredentialing is identical to that for credentialing and is consistent with URAC and State of Oklahoma requirements.
If your application is not available to OSCIPA, you will be added to our roster. CAQH will send you a registration letter and a CAQH Provider ID so that you can complete the UPD credentialing process. This will help you continue to conform to the requirements of your OSCIPA contract.
Keeping your information current is your responsibility. You will be sent automatic reminders to review and attest to the accuracy of your data. Use the CAQH database to report any changes to your practice, in accordance with the time frames outlined in the State of Oklahoma.
You must enter your changes into the UPD database for us to access. Only health plans and organizations that participate in the UPD and that have been authorized by you to access your information will receive any changes.
We rely on the accuracy of the provider information in our directory and our online Find a Doctor tool. This is why it's very important that you inform OSCIPA whenever any of your practice information changes. Complete our Change of Directory Form and update your W9 to change your provider information.
