CAQH and Insurance Credentialing

CAQH and Insurance Credentialing

What is CAQH?

Council for Affordable Quality Healthcare, Inc. (initialized as CAQH) is a non-profit organization incorporated in California as a mutual benefit corporation. It is essentially an online portal that stores provider information in a secure, collaboration database.  This secured information 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 go in and pull it directly from your file.  90% of the National Health Insurance Companies use CAQH and it is a prerequisite for the insurance enrollment process in most states.

The mission of CAQH is to improve health care access and quality for patients, and at the same time, reduce the paperwork and hassle for health care providers and their office staff. The objective is to only fill out your credentialing information one time through this universal application and eliminate the need to fill out applications for each individual insurance company. Most insurance companies now require you to have a CAQH id prior to initiating the credentialing process.

There are no fees to physicians and other healthcare providers to use the database. Participating in CAQH health plans and healthcare organizations pay the costs of developing and maintaining the system. The CAQH system is secure so that only healthcare organizations authorized by a physician or other healthcare provider have access. Providers have access only to their own data—not that of others.

CAQH and Insurance Credentialing

As you know, the insurance credentialing process can be a painful one with all of the various credentialing applications and insurance carriers.  It’s stressful and time-consuming to go through each insurance companies unique credentialing process.  This is where having all of your information in a central database becomes so helpful to the various organizations you work with.

Physicians and other healthcare providers submit their credentialing information to the system database online, or via fax. Organizations requiring provider credentials access the system for the information they require. The CAQH database administrator contacts physicians and other healthcare providers quarterly to update or validate the information via email or fax and will provide information only to organizations the provider has authorized. Plans will automatically be notified of any updates or changes to provider information.

A typical physician or other healthcare provider contracts with as many as 10 to 20 healthcare organizations, each of which requires a time-consuming credentialing application. The amount of time associated with the credentialing application process is dramatically reduced through the use of a standard application submitted to a single source. In short, this system means one doctor, one application, and one secure database for all participating health plans. It represents a move from paperwork to more efficient online information gathering.

Attesting your CAQH profile is the process of signing off on your CAQH application at the end of the application process.  In addition to initially attesting, you have to go back in and attest every 90 days which keeps your application active and provides your contracted insurance carriers with up-to-date credentialing information.  Failure to attest your CAQH application will result in your credentialing/re-credentialing applications with the payers being delayed or rejected.  It’s critical that you keep up with CAQH and ensure your information is accurate.  Every time you receive a new malpractice policy, license, DEA certificate, W9 or address, it’s critical that you get this information updated in CAQH.

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