Guidance on CAQH Application Process

Before we dive into the CAQH application process, let’s understand what is CAQH and why creating an account in CAQH is required for provider credentialing.

What is CAQH?

CAQH is required for healthcare provider credentialing because it provides a centralized database of provider information that can be accessed by multiple healthcare organizations. CAQH (Council for Affordable Quality Healthcare) is a non-profit alliance of health plans and related organizations that promotes the simplification of healthcare administration. Many health plans and healthcare organizations require providers to be registered with CAQH and maintain their accurate and up-to-date information.

CAQH provides a centralized database of provider information that can be accessed by multiple healthcare organizations. By using the Universal Provider Data source (UPD), healthcare organizations can verify the credentials and qualifications of providers in a more efficient and accurate manner. This eliminates the need for providers to submit the same information to multiple organizations and reduces the administrative burden on both providers and healthcare organizations.

CAQH Application Process

CAQH offers a variety of healthcare-related solutions, including a universal provider credentialing service known as CAQH ProView. The CAQH ProView application process is used by healthcare providers to centralize and streamline the credentialing and contracting process for participation in healthcare networks, plans, and organizations.

The CAQH application process involves several steps, including:

Registering for an account:

Healthcare providers must create a CAQH ProView account before they can start the application process. To do this, they need to visit the CAQH website and click on the ‘Register’ button. They will then need to provide some basic information such as their name, email address, and NPI (National Provider Identifier) number.

Completing the application:

Once registered, providers can begin filling out the CAQH ProView application. This involves answering a series of questions and providing supporting documentation to verify their credentials, such as education and training, work history, licenses and certifications, malpractice insurance, and more.

Reviewing and submitting the application:

Once the provider has completed the application and uploaded all required documentation, they will need to review the application to ensure everything is accurate and complete. They will then need to electronically sign the application and submit it to CAQH for review.

Credentialing verification:

After submitting the application, CAQH will review and verify the provider’s credentials, which may include contacting the provider’s references, licensing boards, and other relevant entities.

Updating the application:

Providers must keep their CAQH ProView application up-to-date by regularly updating their information and submitting new documentation as necessary.

The CAQH ProView application process is designed to simplify and expedite the credentialing and contracting process for healthcare providers. By using CAQH, providers can streamline the application process, reduce administrative burdens, and gain access to a wide range of healthcare networks and plans.

List of Documents for CAQH Application

To complete your CAQH ProView application, you will need to provide the following documents:

• Personal Information: Your name, address, phone number, email, and date of birth.
• Education: Information about your education, including the name of the school(s), dates of attendance, and degree(s) earned.
• Work history: A list of your previous work experience, including the name of the employer(s), job title(s), dates of employment, and a brief description of your duties.
• Licenses and certifications: A list of all licenses and certifications you hold, including the issuing authority, the date of issuance, and the expiration date.
• Professional liability insurance: Information about your professional liability insurance, including the name of the carrier, policy number, and expiration date.
• Professional references: The name, phone number, and email address of at least two professional references who can attest to your work experience and qualifications.
• Disclosure questions: You will need to answer a series of disclosure questions about your background, including any criminal convictions or disciplinary actions taken against you.
• W-9 form: This form is used to request your taxpayer identification number (TIN) for tax reporting purposes.
• Supporting documents: You may be asked to provide additional supporting documents, such as your resume, a copy of your diploma or transcripts, or proof of your professional liability insurance coverage.

Please note that the specific requirements may vary depending on the type of provider you are and the requirements of the insurance companies or health plans with which you are affiliated.

List of Payers Required CAQH Account

Many payers require healthcare providers to have a CAQH ProView account to simplify and streamline the credentialing process.

Here are some payers that may require a CAQH ProView account:

• Aetna
• Anthem Blue Cross Blue Shield
• Cigna
• Humana
• UnitedHealthcare (UHC)
• Kaiser Permanente
• Medicare
• Medicaid

Please note that this list is not exhaustive and may change over time. It is always best to check with each individual payer to determine their credentialing requirements.

About Medical Billers and Coders (MBC)

Medical Billers and Coders (MBC) is a leading revenue cycle management company providing complete medical billing and coding services. MBC's credentialing services are designed to help healthcare providers and organizations streamline their credentialing process, reduce administrative burdens, and ensure compliance with regulatory requirements. MBC's credentialing team consists of experienced professionals who can assist with provider enrollment, primary source verification, and other aspects of the credentialing process.

MBC's credentialing services can be particularly helpful for healthcare organizations that are struggling to manage the complex and time-consuming task of credentialing, or for providers who are new to the industry and need guidance in navigating the credentialing process. To know more about our provider credentialing and enrollment services, email us at: info@medicalbillersandcoders.com or call us at: 888-357-3226.

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Published By - Medical Billers and Coders
Published Date - Mar-27-2023 Back