The 3 key foundations of a successful CAQH profile lies in the accuracy and completeness of provider data. Inaccurate or outdated information can lead to severe repercussions, such as contract denials and terminations.
CAQH – What is it?
We are regularly asked about CAQH. “What is it, and what’s the big deal?”
CAQH stands for the “Council for Affordable Quality Healthcare”. CAQH was started in July 200 as a Coalition for Quality Healthcare by several large payors. In August 2002, it became a non-profit alliance of health plans and associates with the goal of streamlining the business of healthcare. It is now the gold standard as a comprehensive resource for provider credentialing.
CAQH Proview
The division of CAQH that providers work with the most is CAQH Proview which is now the healthcare premier resource for providers to self-report their professional and practice information. Over time, we have seen almost all large payor organizations turn to CAQH as their primary source for provider credentialing and re-credentialing.
Why Do I Have a CAQH number?
The CAQH number us the only way to identify the provider and the individual log in and password is created to keep provider information secure.
What if I don’t maintain my information in my CAQH profile?
All major health plans and many smaller plans require a complete and attested CAQH to complete and approve contracts. But it does not stop there, payors use CAQH to re-credential providers every two to three –ars. Payors often do this without notice and if required documents or information has not been maintained, a provider can receive an unexpected notice of termination.
Basic Rules for Managing Your CAQH profile
Complete all section of the data file and upload the usual credential documents. Answer the disclosure questions with facts and dates. It’s a good idea to have your resume on hand to have the correct dates in the file.
To remain current, you must provide regular updates:
Consistently review and update your CAQH profile: This process involves reattesting every 120 days and updating your information whenever significant changes in your professional status or practice details occur. We minimize this burden by requesting regular updates that ensure your data remains current and accurate, reflecting your latest credentials and practice information.
Accuracy and Completeness: When updating your profile, you must ensure that all the information provided is accurate and complete. This includes consistently using official names, correct spellings, and proper formatting. You also must attach all required documents, such as licenses and certifications for them to verify your qualifications and professional standing. We streamline this by maintaining up to date records on file for timely submission on your behalf.
Verification and Review: The smallest errors can have big repercussions. Before submission, thoroughly review your entries for potential errors or omissions. Engaging a colleague or a professional reviewer to inspect the information can help identify and correct mistakes that could lead to discrepancies or delays in your credentialing process.
Following these steps keep you and your practice in good standing. We work to simplify and streamline this process by sending you a simple questionnaire every 90 days. This helps us attest your CAQH accurately on an ongoing basis.
There are three key areas that are reviewed in your CAQH profile:
- Current credential documents
- correct demographic information, keeps a provider compliant with No Surprises
- Review of disclosure questions that are attested based on your answers on the brief questionnaire
CAQH should not be taken lightly, we don’t.
CAQH requires providers to review and attest their information every 120 days. An expired CAQH is an immediate red flag to payor looking to credential or re-credential. As healthcare moves forward in an increasingly digital world, CAQH is playing an important role. CAQH should not be taken lightly. Berkeley & Associates is working hard to keep you in good standing. We don’t take your trust lightly.
This is brief overview of the what and why of CAQH. CAQH can be a lot. Please call 405-210-7234 if you have questions. We are happy to talk with you and assist any way we can.
