HMO Credentialing Form FAQs
If you have additional questions, call 573-526-4106 or email us at LH@insurance.mo.gov
Search for specific items within the CAQH Form UCDS by page number and Section number.
Questions about the switch to the new CAQH Form UCDS:
- Am I required to use the CAQH on-line system?
- Will the old Standardized Credentialing Form continue to be an approved form?
- Will there be a grace period to transition from the old form to the CAQH Form UCDS?
- How much time do HMOs and their credentialing agents have to switch to the new Form UCDS?
- Can I use my organization’s electronic version of the CAQH Form UCDS, instead of the form available from CAQH or from
- I mailed recredentialing packets to participating providers last month. I have received some packets back, but not all. Do I have
to mail out all new packets to all my providers?
- After 1-30-09, will providers still be able to print the old MO Standardized Credentialing Form from the CAQH system?
- Faxing a paper copy to CAQH is a burdensome and resource-consuming process. Can DIFP take any action to speed up the paper submission process?
General Questions about the CAQH Form UCDS:
- When accessing the CAQH Form UCDS on the CAQH web site, is it possible to save in Word format for provider offices that do not have a CAQH provider ID?
- Is the Data Summary the same as the CAQH Form UCDS?
- How does a provider print a paper copy of the CAQH Form UCDS from the CAQH system?
- When I print the Form UCDS from CAQH’s web site or DIFP’s web site, the blue boxes don’t show up well. How do I get the boxes to show up?
- How do I save the fillable PDF? Do I have to complete the whole fillable form before I can save?
- Can I use my company form instead of the Form UCDS from CAQH?
- The CAQH Form UCDS does not ask for information I need. Can I add additional questions?
- What affirmation and release form does DIFP require?
- If a practitioner enters into a Settlement Agreement with the State Board of Healing Arts and the medical license issued to the practitioner is publicly reprimanded, is this required to be disclosed?
- What if a provider does not answer all the questions on the CAQH Form UCDS?
- We credential physicians who have practices solely within a neighboring state. Can we accept their state’s Standard Credentialing Application in lieu of the Missouri application?
- What should happen with providers located in neighboring states, and the neighboring state has their own state mandated form, not the CAQH Form UCDS? Can the provider get the CAQH system to print one form for Missouri and another form for the neighboring state?
- Page 8, Section 4, “Payment and Remittance” – how should I mark the check box in the left margin, “Check Here To Use Office Manager And Office Address As Payee Information”?
Questions about the switch to the new CAQH Form UCDS:
If all information in the CAQH system is up to date and complete, a provider should go to the "Start" page of the CAQH system web site and click the "Print Application" button. For more complete instructions, please go to the user guide posted on CAQH’s website at https://upd.caqh.org/oas/UPDQuickReferenceGuide20080807.pdf, page 26.
No. The old form is retired, although it will persist for a certain amount of time (up to three years) as HMOs transition to the new CAQH Form UCDS.
There is no explicit grace period. However, DIFP understands the time line associated with credentialing activities. It will not be considered a violation of law if an HMO or credentialing agent began the credentialing process prior to 1-30-09 using the old form, and that process is not concluded until some time after 1-30-09. DIFP understands that a provider's credentialing information as collected on the old form may not come up for recredentialing for up to 3 years. Provider files containing the old form may persist for up to three years past 1-30-09. This will not be considered a violation of law so long as it is clear that HMOs and their agents are taking orderly steps to transition to the new CAQH Form UCDS under normal recredentialing time frames. DIFP Bulletin #08-13 provides additional guidance.
Steps towards conversion from the old Standardized Credentialing Form to the new CAQH Form UCDS should begin immediately after 1-30-09. However, complete transition is not necessary immediately. See Bulletin # 08-13 for additional guidance on making an orderly transition.
Maybe. Any accurate reproduction of the CAQH Form UCDS is acceptable to DIFP. You do not need to contact DIFP or get DIFP's permission to use an accurate reproduction. If you are not sure your electronic version is an accurate reproduction, you can send it to DIFP for review. However, an HMO and its credentialing agents MUST accept the CAQH Form UCDS. If an HMO or its credentialing agent develops an electronic version of the form, it MUST continue to accept the paper CAQH Form UCDS, and may NOT require any provider to use its electronic form if the provider furnishes the paper CAQH Form UCDS. In addition, an HMO or its credentialing agents cannot require a provider to use any accurate reproduction to the exclusion of any other accurate reproduction. The original, and all accurate reproductions, must be accepted by HMOs and credentialing agents.
No. DIFP understands that credentialing and recredentialing are lengthy processes. Any credentialing or recredentialing activity that was initiated before 1-30-09, using the old Standardized Credentialing Form, can be completed using the old form. Even if packets were mailed out 1-29-09, the providers who get those packets can go ahead and fill out the old form and return it to you. If the provider takes the initiative to fill out the new CAQH Form UCDS instead, that is also acceptable. As of 1-30-09, HMOs and credentialing agents should be prepared to accept either the new Form UCDS or the old Standardized Credentialing Form, even if they mailed the old form.
Yes. There are 2 situations in which the old form will print from the CAQH system after 1-30-09. First, the system will retain an "image" of the old form for things like accreditation verification. Accessing the image will be a separate process within the system. Second, the CAQH system will not prompt users to move to the new form until it's time to re-attest. The CAQH system cycle for re-attestation is 120 days. Therefore, depending on the date a provider is due for re-attestation, the system may print the old form until as late as about May 30, 2009.
DIFP neither regulates CAQH, nor has any contractual agreement with CAQH. Therefore, DIFP has no authority to change CAQH's processes. However, if delays in the paper process cause any HMO to have an inadequate provider network, then the HMO must pay for out-of-network services at no greater charge to the enrollee. DIFP will enforce this requirement.
General Questions about the CAQH Form UCDS:
Not at this time. DIFP is not aware of any plans for CAQH to offer this option. However, DIFP has established a fillable PDF version that can be saved. The fillable form is posted on DIFP’s web site here.
Open the form in Adobe. Go to the File Menu, select Print and a dialog box comes up. In that box, there is an option to "Print color as black." Check that. The boxes should now show up better when the form is printed.
Download the fillable file from DIFP's web site and save a copy of it on your computer. Open your copy of the fillable PDF in Adobe Reader. If you don't have Adobe Reader, you can download a free copy. Type your information into the fields. At any point you want to stop and save your work, go to the File menu, and select "Save As." You can save as many copies as you need to.
No, not if you're an HMO or a delegated credentialing agent of an HMO, unless such form is submitted to the director of DIFP and the director determines that it is substantially similar to the CAQH Form UCDS prior to its use. Please refer to 20 CSR 400-7.180 for the procedure to request approval of another form. No HMO may require one approved form if a provider presents another approved form.
Maybe. An HMO must demonstrate a need for additional information. Send DIFP a copy of the additional questions you want to ask and explain why you need to ask each one. Explain if any of the additional questions relate to NCQA standards. Be sure the questions you want to add aren't simply another way of asking for information already stated in the CAQH Form UCDS. If DIFP approves the additional questions, they may be used as a credentialing supplement. If DIFP does not approve the additional questions, they may not be used in any form. Be sure they are not appearing in other documentation that you require providers to respond to. Otherwise, an HMO may request additional information to clarify responses obtained on the CAQH Form UCDS. However, HMOs may not routinely require additional information or information that duplicates information on the CAQH Form UCDS.
The standard authorization, attestation and release in the CAQH Form UCDS is required.
Yes. A Settlement Agreement is a public disciplinary action and is considered a stipulated order. Practitioners are advised that the point is complete disclosure. Most health plans reserve the right to terminate participation agreements for failure to disclose such items.
An HMO may determine how much information is required on the CAQH Form UCDS. An HMO is allowed to require providers to complete the entire form, and may reject providers who fail to provide a complete form. Alternatively, an HMO may determine that some items are not necessary. However, an HMO and its credentialing agents must be consistent and nondiscriminatory if the HMO decides some information on the CAQH Form UCDS is not required.
While practitioners may practice solely in a neighboring state, they could still see patients covered by Missouri HMOs, under health plans issued in the state. Missouri HMOs and their credentialing agents are legally obligated to comply with MO's standardized credentialing form, regardless of the location of the provider.
Providers in this situation should be handled the same as they have always been handled. Missouri requires the CAQH Form UCDS, or an accurate reproduction. Compliance with the Missouri requirement really isn't any different now, after adopting the new form, than it was prior to the adoption. Missouri had a different state mandated form from any other neighboring state (except Kansas) prior to the adoption of the CAQH Form UCDS. Missouri still has a different state mandated form from any other neighboring state, except Kansas. If the provider has entered data in the CAQH system, with a primary location in a non-conforming state, that provider cannot print the CAQH Form UCDS from the system, and the HMO may not be able to download all the same data fields from the CAQH system that are downloaded for a Missouri provider. If the HMO requires a paper form from that provider, the provider will have to get a paper copy of the CAQH Form UCDS and fill it out manually.
DIFP has been alerted to the possibility of fraud and embezzlement arising from certain cases where the medical professional did not have sufficient business controls and business office managers were not properly handling provider payments. Providers should make sure that payee information matches applicable W-9 forms for the practice, and exercise prudent business practice controls to prevent any problems.