Effective June 25, 2008, Ohio House Bill 125 requires all Ohio dentists to use the credentialing form prescribed by the Ohio Department of Insurance (ODI). The form is the Council for Affordable Quality Healthcare (CAQH) standardized form, and it is available online at the ODI website. Download and print the form.
Only dentists who are setting up initial participation agreement(s) with Delta Dental or who are due for recredentialing are required to fill out the form. Delta Dental will send a packet of information, including this form, to dentists who are setting up an initial participation agreement or who are due for recredentialing.
All dental benefit carriers are required to use and accept the CAQH form for credentialing Ohio dentists. Dentists can fill out the form and submit copies of the original, completed CAQH form to any carrier. To simplify credentialing, after the initial CAQH form is completed, dental offices can keep the original on file and send a copy to any dental benefit carriers who request it.