What Is CAQH?

 If you're a physician, nurse practitioner, physician assistant, practice administrator, or healthcare professional going through provider credentialing, you've probably heard the term CAQH.

CAQH plays an important role in the healthcare credentialing process because many health plans use CAQH provider information when credentialing and recredentialing healthcare professionals.

Instead of repeatedly supplying the same professional information and documents to multiple participating organizations, providers can maintain much of their credentialing information within a centralized CAQH profile.

Understanding how CAQH works—and keeping your information accurate and current—can help make provider credentialing and payer enrollment more efficient.

This guide explains what CAQH is, how CAQH ProView works, what information providers need, what CAQH attestation means, and why maintaining an accurate CAQH profile is so important.

   CAQH stands for the Council for Affordable Quality Healthcare.

CAQH is a nonprofit organization that develops administrative solutions designed to improve efficiency within the healthcare industry.

One of its best-known solutions is CAQH ProView, an online platform healthcare providers use to enter and maintain professional information that authorized healthcare organizations can access for purposes such as credentialing.

For providers participating with multiple health plans, CAQH can reduce the need to repeatedly submit the same credentialing information to individual organizations.

 CAQH ProView is an online provider data platform that allows healthcare professionals to maintain information commonly required during credentialing and recredentialing.

A provider's CAQH profile can contain information about:

• Education
• Professional Training
• Medical Licenses
• Board Certifications
• DEA Registration
• Practice Locations
• Hospital Affiliations
• Professional Liability Insurance
• Work History
• Professional References
• Provider Identifiers
• Other Credentialing Information

Providers can also upload supporting documents associated with their professional credentials.

Authorized organizations may then access appropriate provider information according to the provider's authorization settings and applicable CAQH processes.

  Healthcare providers often participate with multiple insurance companies.

Without a centralized provider data system, practices could be required to repeatedly submit the same professional information and supporting documents during different credentialing processes. CAQH helps centralize much of this information.

An accurate CAQH profile can help:

• Reduce repetitive administrative work
• Keep provider information organized
• Support payer credentialing
• Support provider recredentialing
• Maintain current professional information
• Reduce avoidable application discrepancies
• Simplify credentialing documentation
• Improve administrative efficiency

However, creating a CAQH profile does not automatically enroll a provider with an insurance company.

CAQH is an important credentialing resource, but payer enrollment and contracting are separate processes.

Many healthcare professionals may be asked to maintain a CAQH profile when participating with commercial health plans and other healthcare organizations.

These may include:

• Physicians
• Nurse Practitioners
• Physician Assistants
• Certified Registered Nurse Anesthetists
• Psychologists
• Behavioral Health Providers
• Chiropractors
• Physical Therapists
• Occupational Therapists
• Podiatrists
• Other licensed healthcare professionals

Whether a CAQH profile is required depends on the organizations with which the provider is credentialing.

 Completing a CAQH profile requires detailed professional information.

Providers should be prepared to supply information in several categories.

This may include:

• Legal name
• Professional identifiers
• Contact information
• Provider type
• Specialty information

Providers may need information regarding:

• Professional school
• Graduate education
• Residency
• Fellowship
• Internship
• Specialty training

Providers should maintain current information regarding applicable:

• State professional licenses
• Controlled substance registrations
• DEA registrations
• Other professional certifications

CAQH profiles may contain information about:

• Primary practice location
• Additional practice locations
• Billing information
• Office contact information
• Practice phone numbers
• Practice addresses

Keeping practice information current is particularly important when providers relocate or join new organizations.

Providers may need to list current hospital or healthcare facility affiliations when applicable.

Current malpractice insurance information may be required, including policy details and coverage information.

Providers may be asked to provide professional work history and explanations for certain gaps in employment.

Accurate dates are important because inconsistencies can create additional questions during credentialing.

Some credentialing processes may require professional references who can verify a provider's experience or clinical competency.

Maintaining organized credentialing documents can make CAQH profile management much easier.

Common documents may include:

• Professional licenses
• DEA certificate
• Board certification
• Malpractice insurance certificate
• Curriculum vitae
• W-9 when applicable
• Identification documents when required
• Other professional certifications

Requirements vary depending on provider type and credentialing circumstances.

   One of the most important parts of maintaining a CAQH profile is attestation.

Attestation is the process through which a provider reviews the information contained in their CAQH profile and confirms that it is accurate and current.

Providers should not simply attest without reviewing their information.

Before completing a CAQH attestation, providers should verify:

• Practice addresses
• Professional licenses
• DEA information
• Malpractice insurance
• Hospital affiliations
• Work history
• Board certifications
• Contact information
• Supporting documents

If information has changed, it should be updated before the profile is attested.

•  Renew a medical license
• Change malpractice insurance
• Relocate a practice
• Add a practice location
• Obtain a new board certification
• Change hospital affiliations
• Join a new medical group
• Update professional contact information

If these changes aren't reflected in CAQH, discrepancies may appear when payers review the provider's information.

Maintaining an accurate profile helps support smoother credentialing and recredentialing.

 Several common mistakes can create unnecessary credentialing problems.

Providers sometimes move locations or join new practices without updating CAQH.

Incorrect addresses can create discrepancies during payer enrollment.

Licenses, malpractice insurance, and other professional documents expire periodically.

Keeping current copies available helps prevent avoidable problems.

Dates listed in CAQH should be consistent with the provider's curriculum vitae and other credentialing applications.

Incomplete profile sections can slow down credentialing if additional information must be requested.

Providers should understand which organizations are authorized to access their CAQH information.

Updating an outdated CAQH profile after an insurance company has already started reviewing an application can create unnecessary delays.

Maintaining the profile proactively is usually much easier.

   CAQH and provider credentialing are closely connected, but they aren't the same thing.

CAQH provides a centralized location for maintaining provider information.

Provider credentialing is the process through which an insurance company or healthcare organization verifies a provider's qualifications.

Payers may obtain information from CAQH as part of their credentialing process, but the payer still performs its own review and determines whether the provider meets its participation requirements.

  CAQH also should not be confused with payer enrollment.

Payer enrollment is the process of applying to participate with an insurance company or health plan.

Completing CAQH does not automatically:

• Enroll you with an insurance company
• Add you to an insurance network
• Create a payer contract
• Guarantee credentialing approval

CAQH supports the credentialing process, while enrollment and contracting involve additional steps.

CAQH can also play an important role during provider recredentialing.

Healthcare organizations periodically review participating providers to ensure their credentials remain current.

Because CAQH contains professional information used by many participating organizations, maintaining an accurate profile can help providers stay prepared for future recredentialing cycles.

    One of the best ways to simplify CAQH management is to maintain an organized credentialing file for each provider.

Keep current copies of:

• Licenses
• Certifications
• DEA registration
• Malpractice insurance
• Curriculum vitae
• Practice information
• Hospital affiliations
• Professional references

When something changes, update your credentialing records and CAQH information promptly rather than waiting until the next credentialing application.

For practices managing multiple providers, maintaining a credentialing calendar can also help track document expirations and other important deadlines.

CAQH stands for the Council for Affordable Quality Healthcare.

CAQH ProView is an online platform used by healthcare providers to maintain professional information that authorized healthcare organizations may access for credentialing and other administrative purposes.

No. Requirements vary depending on the provider and the organizations with which they are credentialing. However, many commercial health plans use CAQH during credentialing.

No.

Maintaining a CAQH profile does not mean a provider has been approved by an insurance company. Credentialing and payer enrollment are separate processes.

No.

CAQH helps maintain provider information used during credentialing. Providers still need to complete the appropriate payer enrollment and contracting processes.

Yes.

Keeping practice information accurate is important because discrepancies between CAQH and payer applications can create additional administrative work.

Yes.

Healthcare practices frequently assign credentialing staff or professional credentialing companies to help maintain CAQH profiles and provider documentation.

Providers should still ensure the information submitted on their behalf is accurate.

  CAQH is only one part of the healthcare credentialing process.

Explore additional resources in the CD Group Credentialing Learning Center:

• Credentialing 101
• ASC Credentialing
• Provider Credentialing Guide
• Medical Privileging
• Credentialing vs. Privileging
• Provider Recredentialing
• PECOS Explained
• Provider Enrollment vs. Credentialing
• Medicare vs. Medicaid

Understanding how these pieces work together can make the entire credentialing process easier to manage.

Managing CAQH profiles can become time-consuming, particularly for practices responsible for multiple healthcare providers.

At CD Group Credentialing, we help healthcare providers and medical practices manage CAQH profiles, provider credentialing, payer enrollment, recredentialing, privileging, and other credentialing requirements.

Our team can help keep provider information organized, current, and ready when credentialing opportunities arise.

Contact CD Group Credentialing today for a free consultation and learn how our CAQH Management Services can simplify your credentialing workload.