What is CAQH credentialing?

All about CDT D0140 Dental Procedure Code Billing Questions
July 28, 2022
What is the average overhead for a dental office?
October 19, 2022

Let’s begin with knowing what CAQH is! It stands for the Council for Affordable Quality Healthcare, a not-for-profit collaborative alliance of the nation’s leading health plans and networks. Its mission is to improve the accessibility and quality of healthcare services for patients and the reduction of the administrative burden for healthcare providers and their office staff.

In simple words, CAQH is an online database that contains information on credentials. Practitioners provide insurance companies with their self-reported demographic, educational and training background, employment history, malpractice history, and other pertinent credentialing data.

Let us have a detailed look at CAQH credentialing.

CAQH credentialing

Health plans and credentialing providers can pay to access the CAQH, a massive database. To simplify the credentialing process, the Council for Affordable Quality Healthcare CAQH collects credentialing information about healthcare practitioners and makes it available to health plans and other healthcare bodies.

Consider the certificates or licenses you now hold that automatically expire periodically. You can upload this pdf file into CAQH, confirm its accuracy, and give all the insurance companies access to the file instead of giving each company an updated license.

By removing a large portion of the paper-based enrollment procedure involved with insurance companies’ network enrollment and facility privilege applications, online accessibility to this information is intended to lessen the administrative load.

Importance of CAQH credentialing

Many insurance providers demand CAQH; there are several exceptions to this rule, as a few states maintain systems that operate similarly to CAQH. There is still a solid reason to enroll with CAQH even if your state has its system because some national organizations initially use the state system but eventually prefer CAQH.

Both basic credentialing and payer recredentialing involve CAQH; this implies that you must update the database. Payers may use your CAQH portfolio when you initially obtain credentials from health insurers and transmit them into their network.

It increases efficiency by reducing the number of repetitive applications or requests for information that must be handled, in addition to serving as a mandate in the majority of states.

How to register with CAQH?

  • Visit https://proview.caqh.org/PR/Registration/SelfRegistration, after you have all the required information for registration ready with you.
  • After filling in all the information, submit a signed attestation document provided by CAQH, and then you will be required to grant access to the payers to your information. This way, you indicate to the payers that you’ve submitted accurate information and your application is ready for review.
  • Make sure to upload the document through their document after signing and dating the release or attestation.
  • Note and save your CAQH ID #, user id, and password. To make sure nothing goes south, check it every ninety days. However, CAQH will email you or the credentialing contact you put to remind you of things that need attention.