Episode 12: Everything CAQH (that you need to know)

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December 01,  2020

What is CAQH?
CAQH (Council for Affordable Quality Healthcare) is nothing more than a giant database of credentialing information. Insurance companies and other credentialing entities pay to access  the information but is free for YOU, the provider.

What does CAQH do and why is it important to you?

  • If you want to be credentialed by an insurance company, you have to send them a whole bunch of documentation--licenses, proof of malpractice, your DEA/state CDS and more. And when each document expires, you have to provided updated documents. 
  • Using CAQH allows you to upload the documents in one central location and have them disseminated to insurance companies rather than having to send the documents to each individual insurance company. It will save you a huge amount of time.
  • CAQH does not submit application to the insurance companies or complete the credentialing process for you.

How to register with CAQH?

  1. Have all of your documents ready for uploading. Make sure your CV is updated. You'll need your license, DEA/CDS, proof of malpractice, CV, W9, proof of board certification, diplomas, and proof of hospital privileges (if applicable.)
  2. Have three professional references
  3. If you are starting a practice you'll also need information about the new entity: the legal entity info, tax id #, address (including payment and correspondence if they're different), billing company info if you are outsourcing, credentialing contact, billing contact, hours of operation, phone/fax, group NPI (if you have multiple providers) and your NPI. 
  4. Once you have everything ready, go to https://proview.caqh.org/pr/registration/selfregistration
  5. At the end of your application you need to grant access to the payers. In order to do this you MUST submit a signed ATTESTATION form provided by CAQH.
  6. Once you have signed and dated the attestation, make sure to upload the document (or nothing will happen).
  7. Save your CAQH ID#, user id and password in a safe place. Check CAQH at least every 60 days to make sure there's nothing that needs attention.

Can you do this yourself? Yes, absolutely. The majority of the time and effort comes from gathering all of the information. You will need to do this part regardless of whether you enter the data in the portal or you outsource it.

Click here to get  my free How To Start Your Own Private Practice Cheat Sheet.

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