Uniform Credentialing Form

MARTIN O'MALLEY Governor ANTHONY G. BROWN Lt. Governor [LOGO] INSURANCE ADMINISTRATION RALPH S. TYLER Commissioner BETH SAMMIS KAREN STAKEM HORNIG Deputy Commissioners 200 St. Paul Place, Suite 2700, Baltimore, Maryland 21202 1-800-492-6116 TTY: 1-800-735-2258 www.mdinsurance.state.md.us # BULLETIN 09-25 Date: October 7, 2009 To: Insurers, Nonprofit Health Service Plans, Health Maintenance Organizations, Dental Plan Organizations, and Managed Care Organizations Re: Uniform Credentialing Form During the 2009 Legislative Session, the Maryland General Assembly amended §§ 15-112 and 15-112.1 of the Insurance Article, Annotated Code of Maryland. The newly amended sections allow the Maryland Insurance Commissioner (Commissioner) to designate a provider credentialing application developed by a nonprofit alliance of health plans and trade associations for an online credentialing system as the uniform credentialing form if the: - Provider credentialing application is available to providers at no charge; and - Use of the provider credentialing application is not conditioned on submitting the provider credentialing application to a carrier through the online credentialing system. CAQH's provider credentialing application meets these requirements. Therefore, the Commissioner designates the CAQH provider credentialing application as the uniform credentialing form to be used by insurers, nonprofit health service plans, health maintenance organizations, dental plans, and managed care organizations. CAQH's provider credentialing application is available on its website at http://www.caqh.org/pdf/CAQH_Provider_Applicationv5_2006-10-31.pdf. Any questions regarding this Bulletin should be directed to the Life and Health Unit at (410) 468-2170. Ralph S. Tyler Insurance Commissioner By: Beth Sammis Beth Sammis Deputy Commissioner