Credentialing Corner

What Is CAQH Credentialing? Why Is It Required by The Provider in Credentialing?

What is CAQH credentialing Why is it required by the provider in credentialing

Credentialing is one of the essential processes for providers to get the permit to work and serve the patients of their practice. It is a systematic approach by which providers are authorized and verified. Providers are credentialed just not for their qualifications but for licensing, certification, training, and registration. But what is CAQH credentialing and how does it work in credentialing a provider? Insurance credentialing is the method through which you become an affiliate to insurance companies to make sure that healthcare providers can easily file reimbursement claims.

People have a lot of misunderstandings regarding CAQH and how to use it. Today, we’ll tell you how to use CAQH and how to register for CAQH. CAQH is an online repository of credentialing data. In addition, an added advantage is that the credentialing using CAQH influences the process of self-reporting by providers in education and self-reporting, demographics, work history, malpractice history, and any other relevant information. These pieces of information are used to create an online credentialing profile so the insurance companies can access and verify the details.

What is CAQH credentialing?

Primarily, CAQH is a large database that helps keep the information of the providers to use by insurance and credentialing companies. These companies pay for accessing the database. CAQH does not work through application submission, but they play an important role in providers’ credentialing process.

What is CAQH credentialing

This works especially when your COI malpractice policy or license expires and is required by the credentialing companies. Instead of providing updated documents to every other insurance company, you can upload your documents to CAQH so they can access them whenever they want. You can upload the attested document and permit the insurance providers to access it.

As the CAQH database is paid software this is why you should not assume that all the insurance companies have the access to your profile to view it. CAQH is not authorized by Medicare, Medicaid, or Tricare, so they do not use it or any government payer. This means many local and regional health plans cannot access the information. Thus, you may have to keep the credentialing documents prepared when it comes to dealing with such payers.

Credentialing and CAQH

From the above discussion, you might have gotten an idea that CAQH is the process of initial credentialing used by payers. This translates to the fact that there is no set and forgets task database, you need to keep it updated and maintain it with your credentials on and off. Sometimes, when you are credentialed for the first time, the payers will access your profile from CAQH and export the information to their system.

In order to access your profile, payers would need your ID, email, or any other information that can provide them access to view your profile. Once your payer will use the information from CAQH, the payer will keep your information updated on their end through CAQH. They might publish your work history, your achievements, any malpractice information, or any other document of experience they had with you. This is why attesting your uploaded documents and revisiting the profile within 90 days is recommended for the providers who use CAQH credentialing.

Importance of CAQH

Many third-party insurance companies have the access to CAQH credentialing software and they need you to provide your CAQH ID to verify the credentials you provided. This is why you might not have enough choices in this area for your practice. Some states share a handful of functions that work somewhere similar to CAQH, so you might get some exceptions in certain states.

Even if the states have their own software, you need to make a profile on CAQH as they might use the state software for credentialing but they ultimately prefer CAQH due to its high efficiency and accuracy.

Besides, as it is a prerequisite in most states, it reduces the number of applications that payers need to send the provider to provide the required additional documents.

How to register with CAQH?

Because CAQH carries extensive information about the provider, you cannot make your profile in just a single sitting. It may take hours to verify, attest, and upload each and every document and credential required for the particular practice.

Importance of CAQH

To speed up the process, it would be one of the best approaches to gather all the information and documents beforehand. Review your certifications and license if they are expired or the expiry date is about to reach, get them renewed first as it may hinder the process, you might need to cancel the request for your profile due to lack of required information, or you might need to delay it just because the expiration date is approaching.

To see what information, you might require in order to complete the CAQH process, consider this list of information to gather prior;

  • Basic personal information
  • Board certification in your specialty
  • Documents of education and training
  • CV or resume
  • Malpractice insurance information
  • Practice information includes the type of practice, location, address, contact, services, information, limitation, partners, billing, covering, hours, certification, office manager, and credentialing service.
  • References and work history
  • Disclosure of malpractice history
  • W-9
  • Various ID numbers (NPI, UPIN, etc.)
  • Controlled and dangerous substances certificate (CDS)
  • Drug Enforcement Administration certificate
  • State License

Once you are sure that you have all the required information and documents needed for registering, visit CAQH.

After providing all the information to CAQH, on reaching the end of the application, you will get a CAQH ID that will be used to provide access to your profile to any payer. But before you give this ID to your payers, you need to sign an attestation letter to CAQH, that you have provided the accurate information to CAQH and are ready to be viewed by the payers.

Once the attestation release is signed, you need to ensure that his attestation will be uploaded to the documents along with the payers’ documents.

All in all, it is also important to keep your CAQH ID, email, and passwords in a safe place, and don’t forget to review your application after every 90 days. CAQH, however, sends reminders to every contact that has provided the information at CAQH credentialing but you cannot rely on their reminders.