If you’ve been in the medical field for any length of time, it’s likely that you’ve already heard of CAQH. However, hearing about it and actually understanding what it does are two different things. There are still a lot of misconceptions about CAQH, what it is, what it does and why it’s used. We’re going to answer these questions and tell you how to register with CAQH.
What is CAQH used for?
CAQH has went through a number of iterations over the years but their core service remains the same. They essentially function as a giant database that insurance companies and credentialing companies can pay to access. CAQH does not submit applications to insurance companies or complete the credentialing process for you but they do play a vital role in this process. Think about your license, malpractice policy (COI), DEA certificate or anything else that routinely expires without your intervention. These documents are needed by the insurance companies and rather than providing each payer an updated license, you can upload this document into CAQH, attest to its accuracy and grant the payers permission to access the file. Not all plans have access to CAQH so it’s important to not assume all payers will have your information once your profile is built. Most local/regional health plans do not access it and none of the government payers use it.
CAQH IS NOT USED BY MEDICAID, TRICARE OR MEDICARE.
When is CAQH Used?
CAQH is used for initial credentialing and for payer recredentialing. This means that it’s not a set it and forget it database but requires maintenance on your part. When you’re first getting credentialed with health plans, some times payers will use your CAQH application/profile and export it into their system. In order to accomplish this, the payer has to be authorized and will often request your CAQH id number over the phone, online or via email.
Once you’re up and running which includes getting contracted(CAQH is not involved in this process) the payer will likely use CAQH to keep your file up to date. This is why remembering to reattest every 90 days and keep your documents updated is so important.
Why you should register with caqh
Well, to start with, CAQH is required by many insurance companies so you really don’t have much of a choice. There are exceptions to this as a handful of states have their own system which functions much like CAQH. However, even if your state has it’s own system(which is rare), it still makes sense to register with CAQH as some of the national plans reluctantly use the state system but ultimately prefer CAQH.
In addition to being a requirement in most states, it improves efficiency by cutting down the number of redundant applications or requests for info that have to be handled.
How to register with caqh
- Have all of your documents ready for uploading and your CV updated. You’ll need your license, DEA (and controlled substance cert if applicable), malpractice certificate, CV, W9, board certificate, hospital privileges(if applicable) and your diplomas. There’s no reason to start an application that you can’t finish.
- Make sure you have three professional references as these are required for your application.
- If you’re starting a practice, you’ll also need information about your new entity including the following: legal entity info, tax id, address (including payment and correspondence if they are different), billing company info if outsourcing, credentialing contact, billing contact, hours of operation, phone/fax, GROUP NPI, etc.
- Once you feel like you have everything ready for submission, visit: https://proview.caqh.org/PR/Registration/SelfRegistration
- Once you’ve made it through to the end of the application, you now need to grant the payers access to your information. Before they can do this you MUST submit a signed ATTESTATION document provided by CAQH. This is you verifying that you’ve submitted accurate information and tells the payers that your application is ready for review.
- Once you sign & date the release/attestation, you want to make sure and remember to upload the document through their document
- Be sure to save your CAQH ID #, userid and password. Keep this in a safe place and remember to check it every ninety days to ensure nothing needs your attention. CAQH is supposed to email you or whoever you put as the credentialing contact but you don’t want to rely on their reminder.
Remember to check out our CAQH Credentialing Service & Practice Start-Up Services
We hope this article helped. We’ve been faithfully serving providers across the country for over 10 years and would love to help you. We offer comprehensive practice start-up services, insurance credentialing/contracting and credentialing maintenance packages to fit every budget.