Provider Credentialing, CAQH

Job highlights

• The CAQH profile technically belongs to the provider,and they should maintain awareness of its content.
• Providers are required to re-attest to the accuracy of their information every 120 days to keep their profile updated

CAQH (Council for Affordable Quality Healthcare) is a non-profit organization that provides a free, universal database, CAQH ProView, for healthcare providers to store and share their professional credentialing information with health plans, simplifying the process for both parties . Through this platform, providers can enter their information once, including licenses and certifications, and then grant access to multiple health plans for their initial credentialing and re-credentialing needs. This centralizes data, improves accuracy, reduces administrative burden, and streamlines the process for providers and healthcare organizations nationwide.

What is CAQH

• A non-profit alliance:

  CAQH is a collaborative effort among healthcare stakeholders, including health plans, providers, and vendors.

• CAQH ProView :

  This is the core of the CAQH platform, a national database where providers can store their professional information and documents.

• Universal Data:

  CAQH provides a single, standardized application that replaces the need for multiple applications from different health plans and networks.

How does CAQH support Provider Credentialing

• Streamlined Data Collection:

  Providers enter their information, licenses, and certifications into the CAQH ProView portal one time.

• Simplified Access:

  Providers can grant health plans, which pay a fee for access, permission to view their profile and download the information for credentialing.

• Re-attestation:

  Providers are required to re-attest to the accuracy of their information every 120 days to keep their profile updated.

• Document Repository:

  The platform serves as a place to upload and store important documents like DEA certificates, medical licenses, and malpractice insurance certificates.

Benefits of Using CAQH

• For Providers:

  • Reduces time and effort spent filling out multiple applications.
  • Provides a single, centralized location for credentialing information.
  • Offers a single CAQH ID that can be used across many health plans.

• For Health Plans:

  • Provides access to accurate and up-to-date provider data.
  • Automates parts of the credentialing workflow, speeding up the process.
  • Helps to build and maintain a high-quality healthcare network.

Important Considerations

• Not universal:

  Not all payers, including Medicare and Medicaid, use CAQH for credentialing, though many commercial insurers and some state programs do.

• Self-reported:

  The information on the CAQH platform is self-reported, so providers are responsible for keeping it accurate and updated.

• Provider ownership:

  The CAQH profile technically belongs to the provider, and they should maintain awareness of its content.