Credentialing and Recredentialing of Health Care Providers

MARTIN O'MALLEY Governor ANTHONY G. BROWN Lt. Governor  # INSURANCE ADMINISTRATION RALPH S. TYLER Commissioner BETH SAMMIS Deputy Commissioner 525 St. Paul Place, Baltimore, Maryland 21202-2272 1-800-492-6116 TTY: 1-800-735-2258 www.mdinsurance.state.md.us # BULLETIN 07-18 Date: December 20, 2007 To: Insurers, Nonprofit Health Service Plans, Health Maintenance Organizations, Dental Plan Organizations Re: Credentialing and Recredentialing of Health Care Providers COMAR 31.10.26 Uniform Credentialing Form The purpose of this Bulletin is to notify insurers, nonprofit health service plans, health maintenance organizations ("HMOs"), dental plan organizations and any other person that provides health benefit plans subject to regulation by the State (referenced in this Bulletin as "carriers") and entities to whom carriers may delegate provider credentialing or recredentialing authority and responsibility (referenced in this Bulletin as "credentialing intermediaries") that the Insurance Commissioner is designating a new Uniform Credentialing Form effective January 1, 2008. The new form replaces the form previously designated as the sole application for a health care provider to be credentialed or recredentialed for participation on a carrier's provider panel pursuant to §15-112.1 of the Insurance Article, Annotated Code of Maryland ("Insurance Article") and by Code of Maryland Regulations ("COMAR") 31.10.26.03. "Health care providers" and "provider panels" have the meanings indicated in §15-112.1 of the Insurance Article. # Uniform Credentialing Form - Changes Effective January 1, 2008, a new Uniform Credentialing Form is designated by the Insurance Commissioner to replace the previous form. The form previously specified (shown) in COMAR 31.10.26.04 should no longer be used after that date when credentialing or recredentialing health care (including dental care) providers for participation on a carrier's provider panel in Maryland. The regulations of COMAR 31.10.26 are modified and amended to delete the old form and reflect the effective date of the new form. The new Uniform Credentialing Form is introduced by this Bulletin and is available in two (2) versions: dental plan organizations shall use the Maryland Uniform Dental Credentialing Form (UDCF 1.1.08) as the sole application for providers to become credentialed or recredentialed for participation on their dental provider panels; all other carriers shall use the Maryland Uniform Credentialing Form (UCF 1.1.08) as the sole application for providers to become credentialed or recredentialed for participation on their provider panels. Both versions of the Uniform Credentialing Form and completion guidelines may be found on the Maryland Insurance Administration's website: www.mdinsurance.state.md.us. As before, the Uniform Credentialing Form may be transmitted by facsimile, or may be filed electronically in any format that contains the data required by the appropriate version of the Uniform Credentialing Form. However, a carrier may not require a provider to submit the form electronically. The electronic form currently used by the Council for Affordable Quality Healthcare ("CAQH") is virtually the same as the new Maryland Uniform Credentialing Form (UCF 1.1.08). Thus, the CAQH's web-based credentialing system may be utilized by a carrier with the agreement of the provider to be credentialed or recredentialed. Should CAQH change its form in the future, carriers may not use the new CAQH form or any other electronic submission form that differs from the Maryland Uniform Credentialing Form (UCF 1.1.08) unless the Administration specifically approves its use. Carriers or their delegated credentialing intermediaries may not, for credentialing or recredentialing purposes, require a provider to modify the Uniform Credentialing Form, submit additional credentialing forms, submit any additional information not specified in the regulation or use any other form not specified in the regulation. # Transition Period As of January 1, 2008, all carriers and their delegated credentialing intermediaries should begin using the new Maryland Uniform Dental Credentialing Form (UDCF 1.1.08) and the new Maryland Uniform Credentialing Form (UCF 1.1.08). Carriers, including dental plan organizations, and their credentialing intermediaries should continue using the old Uniform Credentialing Form for the credentialing or recredentialing of provider applications received before January 1, 2008. Links to the new forms will be highlighted on the homepage of the Administration's website: www.mdinsurance.state.md.us # Summary 1. Effective January 1, 2008, the form previously referenced in COMAR 31.10.26.03 is replaced with the new Maryland Uniform Dental Credentialing Form (UDCF 1.1.08) and the new Maryland Uniform Credentialing Form (UCF 1.1.08); 2. Dental Plan Organizations shall use the Maryland Uniform Dental Credentialing Form (UDCF 1.1.08); all other carriers shall use the Maryland Uniform Credentialing Form (UCF 1.1.08); 3. A carrier may accept the form in an electronic format, but may not require a provider to submit the form in an electronic format; 4. The electronic form currently used by CAQH is the same as the Maryland Uniform Credentialing Form (UCF 1.1.08) and may be used by a carrier with the agreement of the provider. Questions about this Bulletin may be directed to Thomas Marshall, Coordinator Compliance and Enforcement, by phone at 410-468-2217, or by e-mail at tmarshall@mdinsurance.state.md.us.  2