What is the CAQH Credentialing Process
Not having a CAQH ID and completed CAQH application will delay your enrollment with insurance companies, preventing you from getting reimbursed for your services. PPS can complete all CAQH steps on your behalf.
What is CAQH?
CAQH stands for the Council for Affordable Quality Healthcare. It is an online portal that stores provider information in a secure database. Access is granted to health insurance companies during the credentialing process to make acquiring up-to-date provider information more efficient. Instead of calling your office for your work history or a copy of your medical license, they can pull it directly from your file. 90% of national health insurance companies use CAQH, and it is a prerequisite for insurance enrollment in most states.
What is CAQH Attestation?
Attesting your CAQH profile is the process of signing off on your application at completion. In addition to initially attesting, you must attest every 120 days to keep your application active. Failure to attest will result in your credentialing/recredentialing applications being delayed or rejected.
Critical updates required whenever you receive a new malpractice policy, license, DEA certificate, W9, or address change.
Why CAQH is Important to Credentialing
- Fill out credentialing information one time through a universal application, eliminating the need to complete individual applications for each insurer.
- Most insurance companies now require a CAQH ID prior to initiating the credentialing process.
- The CAQH application is very time-consuming and can be confusing — PPS has completed thousands of applications.
Understanding the CAQH Credentialing Process
1. Obtain your CAQH ID by contacting an insurance company or completing the online enrollment process with CAQH.
2. Set up your secure username and password.
3. Complete the online application and send in the required documentation.
4. Complete and sign the attestation form certifying the accuracy of your application.
5. Grant insurance companies access to your online application.
6. You are now ready to start the credentialing/contracting process with insurers.
Estimated Time for CAQH Profile Completion: 3 Business Days
CAQH Proview Login — Key Steps
1. You will always have only one CAQH ID, regardless of how many states or practices you have worked in.
2. Retrieve your CAQH userid at https://proview.caqh.org/Login/ — contact CAQH at 888-599-1771 if needed.
3. Update the contact name and email in your profile so you can reset your password in the future without calling.
4. Review your profile for deficiencies and get all areas updated and attested.
5. If moving or starting a new practice, update CAQH with your new information. Do not delete anything unless certain it will not affect recredentialing.
6. Authorize payers to access your file — failure to do so means insurers cannot access your account.
CAQH Credentialing Costs — If Outsourced to PPS
$200.00
per CAQH application for new providers without a CAQH ID
$150.00
if you already have a UserID and Password but need it set up
Payment accepted by check, bank draft, or credit card.
Established Group — New Provider Credentialing Checklist
Key requirements for credentialing a new provider under an established group:
- Updated and attested CAQH profile with new practice affiliation and start date
- Group list of currently contracted payers (commercial, Medicare Advantage, Medicaid HMOs, Workers Comp, Tricare, TPAs)
- Tax ID (W9 with pay-to address and CP 575/147C letter)
- Hospital credentialing or admitting arrangements if required by payer/specialty
- New or updated malpractice policy listing provider as named insured
- Group's primary billing NPI (Type II)
- Group's Medicare PTAN
Required documentation for each provider:
- Professional state license
- DEA certificate (if applicable)
- Board certification or proof of board eligibility
- PLI certificate (must have expiration date >60 days in future throughout credentialing process)
- Professional school diploma
- Certificates of completion for internships/residencies/fellowships
- CAQH login and password
- PECOS login and password