New Provider Documentation
Welcome to the credentialing information page. This will serve as your comprehensive resource for all necessary forms, documentation, and guidance.
Features
Access all required forms in one convenient location
Step-by-step guides for completing documentation
How to Use This Page
Download necessary forms directly from this page
Follow the detailed instructions provided for each task
Bookmark this page for quick access in the future
We recommend referring back to this page throughout your credentialing process to ensure all requirements are properly fulfilled. Please notify our credentialing department promptly if you anticipate any periods of unavailability, travel, or limited communication access. This ensures we can maintain proper processing timelines. Missing any deadlines could result in your start date being pushed back. If you have questions or need additional assistance, contact the credentialing team for support in the “Contact Credentialing” section.’
To ensure a seamless onboarding experience, all new providers are required to review and complete all New Provider Documentation (links below). Use the New Provider Documentation Checklist to track your progress and confirm completion.
Modio Profile
You will receive an email with a link to Modio at the personal email address you provided to the credentialing team. This email will include detailed instructions how to complete your profile. Please ensure your profile is completed within five days of receiving the Modio invitation. Be sure to click “Save & Next” in each section to avoid losing your data.
Pending Requirements
If you’ve recently applied for your DEA or Ohio Medical License, please enter placeholder information for now. We will update your profile once your official documentation is received. If you currently hold an out-of-state license or DEA registration, please ensure these credentials are updated to reflect Ohio as your practicing state.
Example Placeholders:
Ohio Medical License:
OH12345678DEA Number:
123456789Status: Mark as “Pending”
CAQH Information
If you have a CAQH Number and login info:
Enter this information into Modio.
Send us a separate email containing your CAQH Number and login credentials.
We need this to add MPAS to your profile.
If you do not have a CAQH Number, let us know — we’ll help set up your CAQH profile.
New Provider Documentation Helpful Tips
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OhioHealth Application Process
To join OhioHealth, complete your application within three weeks of receiving the DocuSign form. Please complete the information not already provided in the prefilled application.
TB Blood Test & Fingerprint Screening – These items have time sensitive requirements, please start these processes as soon as possible.
Application Submission – Once submitted, OhioHealth credentialing will review your application.
Upon submission of your application to OhioHealth by our MPAS credentialing team, OhioHealth will conduct a thorough review. Following their assessment, OhioHealth will email you either to request additional information/corrections or to confirm that your application is complete. We strongly encourage you to regularly check your inbox for this critical communication.
Next Steps:
After review, you will receive an email stating whether your application is complete or requires corrections. This will initiate the credentialing process for your designated practice location, such as Riverside Methodist Hospital.
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Fingerprinting Appointment for Ohio Residents
Ohio residents can schedule a fingerprinting appointment with FastFingerprints by following these steps:
How to Schedule Your Appointment
Visit FastFingerprints (link to the website).
Select “I HAVE A CODE.”
Enter the Access Code: 12KEV2S8.
Click “Verify Code.”
When asked, “Was your code provided by 'OhioHealth'?” select “YES.”
Enter your zip code and select a mile radius, then click “SEARCH.”
Choose a convenient location and click “SELECT LOCATION” followed by “NEXT.”
Complete the following:
Schedule a time for your appointment.
Enter the required applicant information.
Verify and confirm your details, sign, and submit.
Important Appointment Information
Bring a valid, government-issued photo ID (driver’s license, state ID, passport, military ID, or green card) to your appointment.
Need Assistance?
For questions about the scheduling process, contact FastFingerprints:
Email: customersupport@fastfingerprints.com
Phone: 614-457-8900 -
Review this guideto help you through the process
Follow this Link and complete the directions listed below
Log into I & A (use your NPPES log-in/password)
On the HOME page, click the MY CONNECTIONS tab
Under the “Search by” is a box and your name
Click the “plus sign” inside the box
Click “Add Surrogate”
In the NPI field type: 1598703951 and click “search”
Under “Search Results” should be Midwest Physician Anesthesia Services, Inc.
Click on the circle next to Midwest Physician Anesthesia
Then check the boxes for: PECOS and NPPES
Click Continue
Click Submit
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For Central Ohio Residents:
TB blood testing must be completed at an OhioHealth Associate Health and Wellness (AH&W) location. To begin the process:Complete this form.
AH&W will process your test order.
Take the order to an OhioHealth lab to complete your blood draw.
Once your results are available, obtain a copy and submit it to the credentialing team.
A list of AH&W locations can be found here.
For Out-of-State or Non-Central Ohio Residents:
If you are outside the Central Ohio area, TB blood testing can be completed at a participating location through JasonHealth.com. Use the link to find a testing facility near you. Once you receive your results, please forward them to the credentialing team.Previously Completed Testing:
If you have completed a TB blood test within one year of your OhioHealth application date, submit a copy for review. A credentialing representative from MPAS will contact you regarding approval or additional testing requirements.For any questions, please reach out to the credentialing team.