Regulatory Notice to Ohio Providers

Pursuant to Ohio HB 125, Integrated Health Plan is required to provide you with a Summary Disclosure Form describing the terms and conditions of our provider contract. HB 125 also requires us to use a specified application form (the "CAQH" form) for credentialing purposes. To access these forms and to find out more about HB 125, please enter the user name and password below. If you do not have the user name and password for this purpose, please call our Provider Relations Department.

The following link to the Ohio Department of Insurance contains more information about HB 125 as well as a link to the CAQH form:

http://www.insurance.ohio.gov

The following link will take you directly to the CAQH form:

http://caqh.org/credapp/

IMPORTANT: Once the CAQH form is completed, please submit it using one of the following methods: electronically, by fax, or by certified mail, return receipt requested. If the form is submitted to us via any other method we will be unable to accept it. If you would like an email address or fax number to send it to, please contact our Provider Relations Department.

 

 TitleModified DateSize 
OHSDF4/8/2013UnknownDownload