How to use CAQH for credentialing?

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:

1. Get your CAQH ID (within 2-3 business days)
2. Create login credentials (username and password)
3. Complete the online application, review all the information for accuracy and upload supporting documents
4. Certify the application by sending your attestation for signature
5. Authorize insurance firms to access your online application

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: 

• Personal details
• Educational and training information 
• Specialties and approval by the Commission
• Practice location information including name and type of work, address, contact details, facilities, certifications, billing, restrictions, hours, partners, office manager, colleagues, and professional credentials
• Insurance malpractice investigation
• A history of work and references
• History of discovery and malpractice

You would also need the following materials to complete your application:

• Your CV
• Policy(s) on Abuse of Insurance
• W-9(s)-W-9 Form
• State licence
• Different ID numbers (UPIN, NPI, etc.)

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:

• Check if your resume has all the details correct and in proper flow
• Date format should be as MM/YYYY and no work lapses. Your application is likely to get rejected if the date format is not correct. 
• Make sure there are no gaps. You'll need to fill the gaps if there are any (even if it's only a day)
• Keep scanned copies of all necessary materials, as you will be asked to upload them as a part of the application process.

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.