CAQH Profile Guide - Oklahoma

Step 3 - Add Rula practice location

Part 1: Add practice details

1. Go to Practice Details, click “Add Location” and go to the Practice Details tab. You will enter Rula-specific information in this step, do not enter your personal preferences. Please enter the following information exactly as provided so that we can register you with our network.
   
   
   
   
2. Go to the Location Address section and enter the following details:
   

   Field	Information
   Practice Location Name	MENTAL HEALTH SPECIALTY GROUP, PA
   Street 1	101 PARK AVE
   City	OKLAHOMA CITY
   State	OK
   Zip	73102-7209

   
   
   
3. Go to the Digital Directory Information section and enter the following details:
   

   Field	Information
   Practice Location Email	credentialingteam@rula.com
   Practice Location & Appointment Website	www.rula.com

   
   
   
4. Go to the Phone Numbers section and enter the following details:
   

   Field	Information
   Appointment Phone Number	323-205-7088
   Fax Number	833-419-0181

   
   
   
5. Go to the Business Identifiers section and enter the following details:
   

   Field	Information
   Tax ID	86-2493019
   Type of Tax ID	Group
   Organization (Type 2) NPI	1801472634

   
   
   
6. Click “Save and continue”
   
   

Part 2: Add provider at the location information

1. Go to Provider at Location tab. Please enter the following information exactly as provided so that we can register you with our network.
2. Go to Affiliation section and enter the following details:
   

   Field	Information
   Please describe your affiliation with this location	“I see patients by appointment at least one day per week on a regular basis”
   Provider’s Start Date	Choose today’s date
   Is this your primary practice?	If you do not have an existing primary practice in your profile, select “Yes”

   
   
   
3. Go to Practice Limitations and enter the following details:
   

   Field	Information
   Select “Age”	Enter minimum of 5 and maximum of 99 *This will not affect the patient age preferences you’ve shared with Rula

   
   
   
4. Go to Patients and enter the following details:
   

   Field	Information
   Do you accept all new patients at this location?	“YES”
   Do you accept New Patients at this practice Location?	“YES”
   Do you accept existing patients with a change of payor at this location?	“YES”
   Do you accept Medicare Patients at this location?	“NO”
   Do you accept new Medicaid patients at this location?	“NO”
   Do you accept new patients from physician referrals (i.e., referring letter) at this location?	“YES”
   Does this information vary by health plan?	“NO”

   
   
   
5. Click “Save and continue”
   
   

Part 3: Add services and resources information

1. Go to Services and Resources tab. Please enter the following information exactly as provided so that we can register you with our network.
2. Go to Telehealth section and enter the following details:
   

   Field	Information
   Select the following:	“I provide telehealth services”
   Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?	“YES”
   Telehealth Service Type	Audio/Video

   
   
   
3. Go to Payment and Remittance section and enter the following details:
   

   Field	Information
   Billing Policies	“This practice offers Electronic Billing”

   
   
   
4. Go to Office Personnel section and click “Add”
   
   
   
   
5. Select “Billing Contact” and enter the following details:
   

   Field	Information
   What Support does the person provide?	Billing Contact
   First Name	Melissa
   Last Name	Vilmin
   Street 1	PO Box 746878
   City	Atlanta
   State	GA
   Zip Code	30374-6878
   Fax Number	866-277-9071
   Email Address	billing@rula.com

   
   
   
6. Select “Save and add another” and enter the following details:
   

   Field	Information
   What Support does the person provide?	Office Manager/Business Staff Contact
   First Name	Gabe
   Last Name	Diop
   Fax Number	866-280-0260
   Email Address	credentialingteam@rula.com

   
   
   
7. Select “Continue”
   
   
8. Go to Mailing Address section and enter the following details:

   Field	Information
   Street 1	500 Westover Dr
   Street 2	# 13619
   City	Sanford
   State	NC
   Zip Code	27330

   
   
   
9. Go to Phone Coverage section and enter the following details:
   

   Field	Information
   Select	“This location provides 24 hour / 7 day per week phone coverage”
   Phone coverage type	“Other”

   
   
   
10. Click “Save and complete”
    
    
    

Step 4 - Add Rula credentialing contacts

1. Go to Credentialing Contact and click “Add”
   
   
   
   
2. Enter this information, location address information is not required here:
   

   Field	Information
   First Name	Jeffrey
   Last	Morris
   Fax	833-419-0181
   Email address	credentialingteam@rula.com

   
   
   
3. Click “Save and continue”
   
   

Step 5 - Complete and review professional info

1. Go to Professional Liability Insurance and, using your current certificate of insurance, add the required details.
   
   • Reminder – Your liability insurance must include the following:
     • Your name listed as the insured
       • If you have an LLC and the insurance is under a group name, you must be listed as the owner and covered under the policy. Contact your carrier to have them add your name as owner under the group name.
     • Minimum of $1M Occurrence and $3M Aggregate coverage
   • Reminder – Please do not click the FTCA coverage checkbox–this is not a standard insurance. It is only for those who are employed and covered under a federal clinic program.
     
2. Click “Save and continue”
3. Go to Employment Information and include all of your healthcare work experience.
   • If you have fewer than 5 years of work experience, please include all experience while under supervision.
   • For employment gaps that exceed 3 months in your work history, please add the  explanation directly to your CAQH profile
   • Be sure to include MENTAL HEALTH SPECIALTY GROUP, PA in this section, using the start date as today’s date. This is still recommended even though you are contracted rather than employed.
4. Go to Professional References and include 3 references. References from licensed professionals are preferred.
5. Go to Disclosures and ensure all questions are answered correctly
   • Provide a detailed explanation for any questions answered unfavorably

Step 6 - Authorize for review

1. Go to Authorize and select the Authorization Setting tab
2. Select “Yes. Release my data to any organization that requests access”
   • This is essential for our partners to be able to review your profile. You cannot be credentialed with us or our payer partners without this selected.
   • Reminder: The general public never sees your CAQH profile, only authorized health plans and affiliations.
3. Check “I hereby authorize the release of my full set of CAQH self-reported information as indicated above.”
4. Click "save."

Step 7 - Attest your profile

1. Select “Review & Attest”
   
   
   
   
2. If any errors are present, make necessary corrections.
   
   
   
   
3. Select “Attest”
   
   

Step 8 - Upload required documents

1. Go to Documents and upload required documents including:
   • (Only new profiles) CAQH release form
     • Print this form from the documents section in the profile navigation bar. On the document, print your name, then sign & date the form. Scan it to upload back to your profile. 
   • Certificate of insurance. This is usually a PDF document provided by your insurance carrier. 
   • Any additional state-required documents that are indicated
     
     

Step 9 - Return to your Rula account to continue set up

Great work! You are one step closer to seeing clients. Now that you have completed your CAQH profile, return to your Rula account to confirm that your profile has been updated and continue getting set up.

Reminders

• Don’t change the required information you’ve added to your CAQH profile. This information links your profile to our network, please do not change it so that your credentialing process runs smoothly.
• Please note that our practice location and credentialing contact are subject to change. We may request that you update our information.
• Re-attest your CAQH profile every 120 days. You will receive email reminders from CAQH to reattest your profile.
• Ensure that your NPI account is up to date. To ensure that your claims are not denied, log into your NPI account and ensure all information matches the details on your license.