CAQH (Council for Affordable Quality Healthcare), is an online data repository of credentialing data that stores information about medical professionals including their work history, training, education demography, malpractice history, and other relevant or applicable information required for healthcare providers, which is also applicable for a few dental insurances as well.
CAQH plays a crucial role in the credentialing process as it allows the insurance firms to access your details and documents such as license, DEA certificate, and malpractice policy that regularly expires without your notice. Instead of providing your documents to different payers, you can simply upload the attested copies into CAQH and allow the payer to access your information.
CAQH is used by 90 percent of the National Health Insurance Providers and is a requirement for their enrolment. However, government insurance companies do not use CAQH.
Use CAQH for Credentialing
CAQH is used for primary credentialing and payer re-credentialing. It’s a database that needs to be revised regularly on your part. The CAQH Credentialing process involves the following steps:
Now, after performing the above steps, you can start the credentialing process with the insurance companies as they will be able to access your profile along with the documents that you have submitted to support your application.
Create Profile on CAQH
You can follow the steps below to complete your profile on CAQH.
STEP 1: Get the CAQH ID
Before starting the credentialing process with an insurance provider, you must create your CAQH profile. After creating and submitting the profile, you will receive your CAQH provider ID. In case you don’t receive it contact the CAQH ProView support.
STEP 2: Keep all your Documents and Records ready
Here are some details that you need to fill out for the CAQH:
You would also need the following materials to complete your application:
You may need to submit the certificate from Drug Enforcement Administration (DEA) and Certificate of Controlled and Dangerous Substances (CDS), if applicable. Also, keep the following things checked so that your application is neither delayed nor denied:
STEP 3: Fill in your profile
When all of your documents are ready, it’s time to finish your profile at CAQH website. Filling the online application is advised as application on paper is extremely long.
When all the necessary information has been submitted, you will be notified by the website to review all the information and verify the same. You will get a message about the completion of your profile. You can either allow any insurance firm to access your profile or manually choose specific insurance firms to grant access to your profile, as CAQH gives you these two options to choose from. The first option is generally good to go with if you want to have as many panels as you can, while the second option is better if there are one or two organizations that you would like not to work with.
While you only need to complete your profile once regardless of how many insurance panels you apply for, quarterly you will be asked to test the details again. So, don’t lose any of your application details and respond quickly to such requests, as failing to do so will cause insurance providers to refuse to pay claims. On average, it takes just a few minutes to complete.
STEP 4: Re-Attestation
After your application is complete, CAQH will notify you quarterly to re-attest all the information and update the supporting documents. This allows the participating organizations accredited by a provider to access profile information from CAQH based on their various periods of re-credentialing.
If a participating CAQH entity wishes to access information about a provider, it will not be available until the provider completes the process of re-attestation.