What is CAQH?

The Council for Affordable Quality Healthcare (CAQH) is a non-profit organization that develops and leads programmes that have a positive impact on the healthcare industry. CAQH accelerates the transformation of business processes by collaborating and innovating, bringing value to providers, patients, and health insurance.
CAQH recognizes that electronic data availability and sharing is causing a revolution in our country’s healthcare system, and that access to accurate, timely provider data is crucial to its success. Today’s healthcare organizations will suffer if they do not have timely access to provider data.

Credentialing

The process of obtaining, verifying, and evaluating a practitioner’s or provider’s qualifications to provide care or services in or for a health system is known as credentialing.
CAQH predicts that expediting the exchange of credentialing information on a single platform might save as much as $2.26 billion per year on a national level.

What is the objective of CAQH and why is it essential to medical providers?

• If you want to be credentialed by an insurance company, you’ll need to provide them with a slew of documents, including licenses, malpractice verification, and your DEA/state CDS, among other things. You must also produce updated documentation when each document expires.
• Rather than having to transmit the paperwork to each individual insurance company, CAQH allows you to post them in one single spot and have them dispersed to them. It will help you save a lot of time.
• CAQH does not submit insurance applications or finish the credentialing procedure on your behalf.

CAQH estimates that maintaining directory records costs carriers $2.65 billion each year.

When it comes to payor enrollment and applying to a new insurance network, your CAQH account is crucial. We urge that new and existing physician practices and providers double-check that their CAQH accounts are active and up to date.
Your payor enrollment applications may be delayed or rejected if you do not have a properly registered account or if your account is out of current.

How can I become a member of CAQH?

Make sure you have all of your papers ready to upload. Make sure your curriculum vitae is up to date. Your license, DEA/CDS, malpractice proof, CV, W9, proof of board certification, degrees, and proof of hospital privileges are all required (if applicable.)

Three professional references are required.

• If you’re starting a practice, you’ll also need the following information: legal entity information, tax identification number, address (including payment and correspondence if they’re different), billing company information if you’re outsourcing, credentialing contact, billing contact, hours of operation, phone/fax, group NPI (if you have multiple providers), and your NPI.
• Go to https://proview.caqh.org/pr/registration/selfregistration once you have everything ready.

You must allow access to the payers at the end of your application. You must submit a signed ATTESTATION form issued by CAQH in order to do so.

• A list of frequently asked questions has been provided to assist you in getting started.
• Make care to post the attestation after you’ve signed and dated it (or nothing will happen).
• Keep a safe place for your CAQH ID#, user id, and password. Check CAQH at least once every 60 days to make sure nothing needs to be done.

How can I check if my CAQH Proview account is active or not?

Log into your CAQH Proview Account and check the status of your profile to see if your CAQH account is operational.
You can log in to your CAQH ProView account by CAQH Proview
Once you’ve logged in, go to your account profile page to check your status. Please do not hesitate to contact us if you have any issues concerning your CAQH ProView status. We’re here to assist you.

How can I tell if my CAQH account is current?

Keeping your CAQH ProView account up to current can be difficult, especially in 2021, when the way telemedicine is managed and coded is changing dramatically.
Fortunately, CAQH does a great job of keeping its members informed by providing updates and announcements. Visit CAQH.org for the most recent news and announcements, or click here to go to their website’s news and updates area.

According to a CAQH study, many firms employ numerous ways for credentialing, and switching to a single platform could cut annual credentialing expenditures by 40%.

Payor Enrollment Mistake #1: Make sure your CAQH account is up to date before beginning the credentialing process.