What is the CAQH Credentialing Process?

What is CAQH?

What is CAQH attestation?

Why does CAQH matter for credentialing?

How do you log in to CAQH?

How much does PPS CAQH assistance cost?

Adding a provider to an established group

Steps for the existing practice

1. Update and attest your CAQH profile with the new practice affiliation and start date. Confirm that your licenses and any required DEA or state controlled-substance registrations cover the location where you will practice.
2. Obtain the group’s current contracted-payer list, including applicable commercial plans, Medicare Advantage plans, Medicaid managed care plans, workers’ compensation networks, TRICARE, and third-party administrators.
3. Gather the group’s tax ID documentation, such as a CP 575 or 147C letter, and a completed W-9. Provide these to payers and upload them to CAQH when requested.
4. Check each payer’s hospital-privilege requirements for your specialty. Enter current privileges or a qualifying admitting arrangement in CAQH, as applicable.
5. Obtain a malpractice certificate that reflects the provider’s coverage at the new practice and identifies the covered provider. Upload the current certificate to CAQH.
6. Have the group’s Type 2 NPI and tax ID available for payer applications.
7. Have the group’s Medicare enrollment details, including its PTAN where applicable, available for reassignment of benefits.

Provider documents and account access

• Professional state license
• DEA registration, if required for your practice and location. Confirm any state-specific registration requirements before you begin work.
• State controlled-substance registration, if applicable.
• Board certification or proof of board eligibility
• Current professional liability insurance certificate. Check the payer’s requirements for coverage dates and renewal documents.
• Professional school diploma
• Certificates of completion for internships, residencies, and fellowships.
• CAQH Provider ID and an agreed process for authorized profile support. Provide identity information only through the appropriate secure process.
• Authorized PECOS access through CMS Identity & Access Management. Use the appropriate staff or surrogate role instead of sharing login credentials.
• Authorized access to the applicable state Medicaid enrollment portal.
• Authorized Availity user access, if needed. Keep individual passwords and backup codes private.
• Current CV with complete education, training, and work-history dates in the format requested by the application.
• Hospital privileges or admitting-arrangement information, if required, including the hospital, staff category, and appointment date.

Credentialing a new practice

Steps before you apply

1. Establish the business as appropriate for your state and practice structure, then apply for an EIN through the IRS when required.
2. Save the IRS EIN confirmation letter, commonly called the CP 575, when your EIN is issued.
3. Confirm your practice’s service address before completing payer applications.
4. Determine whether your entity needs a Type 2 organizational NPI, then apply through NPPES. A sole proprietor uses a Type 1 NPI. PPS can assist through appropriate authorized access. See our NPI registration guide.
5. Update and attest your CAQH profile. If you need a CAQH ID or help recovering an existing account, read our CAQH registration guide.
6. Identify the payers you want to work with, including relevant commercial plans, Medicare Advantage plans, Medicaid managed care plans, workers’ compensation networks, TRICARE, and other networks in your market.
7. Complete Form W-9 using the correct name, tax classification, taxpayer identification number, and address. Follow the form instructions for your business structure, including any disregarded-entity rules.
8. Confirm whether your specialty and target payers require hospital privileges or an admitting arrangement, and start any required hospital application.
9. Establish a stable office phone number and, if required, a fax number for applications and public directories. Avoid temporary contact information that will require repeated updates.
10. Arrange appropriate malpractice coverage with your insurance professional. Confirm the required limits and effective dates with each payer, address any coverage gaps, and upload the current certificate to CAQH.
11. Authorize the participating insurance companies that need access to your CAQH profile.
12. For Medicaid enrollment, check your state’s documentation requirements. Depending on your entity and services, these may include business registration records, liability coverage, workers’ compensation coverage, and a CLIA certificate or waiver.
13. Once your information is ready, follow each payer’s instructions for applications and letters of interest. Keep submission confirmations and reference numbers. Medicare applications can be completed through PECOS; Medicaid enrollment follows the process established by each state.

Practice documents

• CP 575 or 147C letter
• Signed W-9.
• Business license, if required for your location.
• Fictitious name registration or permit, if required.
• Articles of incorporation or organization, as applicable to your entity.
• General/commercial liability insurance coverage
• Workers’ compensation coverage for the practice, if required.
• CLIA certificate or waiver, if applicable.
• Bank verification letter or voided check, as requested by the payer. See the Medicare bank letter template.

Provider documents and account access

• Professional license
• DEA registration, if required for your practice and location. Confirm any state-specific registration requirements before you begin work.
• State controlled-substance registration, if applicable.
• Board certification or proof of board eligibility
• Current professional liability insurance certificate. Check the payer’s requirements for coverage dates and renewal documents.
• Professional school diploma
• Certificates of completion for internships, residencies, and fellowships.
• CAQH Provider ID and an agreed process for authorized profile support. Provide identity information only through the appropriate secure process.
• Authorized PECOS access through CMS Identity & Access Management. Use the appropriate staff or surrogate role instead of sharing login credentials.
• Authorized access to the applicable state Medicaid enrollment portal.
• Authorized Availity user access, if needed. Keep individual passwords and backup codes private.
• Current CV with complete education, training, and work-history dates in the format requested by the application.
• Hospital privileges or admitting-arrangement information, if required, including the hospital, staff category, and appointment date.

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