What is CAQH?

Published on February 19, 2024

What is CAQH?

CAQH stands for The Council for Affordable Quality Healthcare, Inc. and collaborates with health plans, providers, and related organizations to make the business of healthcare more streamlined and efficient. (caqh1)

The CAQH Provider Data Portal is an online data repository of credentialing data. Healthcare Providers store their demographic, education and training, work history, malpractice history, and other relevant credentialing information within their own secure online platform. Providers can log in anytime from anywhere, and can approve access for payers, hospitals, provider groups, and credentialing agencies. 

How Do I Participate with CAQH?

To register for a CAQH Provider Data Portal profile go to https://proview.caqh.org/PR/Registration. You will receive an email with your CAQH ID number and link to create a username and password. Once done go to https://proview.caqh.org to begin a step-by-step process of inputting data into your profile.      

If you prefer, the Provider Enrollment Department of PPM Partners can help you obtain your CAQH ID and complete your online profile. We can maintain your profile but only for the anesthesia groups we enroll you with.

There is a common misconception that the only thing a provider needs to do is complete CAQH and it will automatically enroll them with all the health plans. CAQH is just one tool used for provider enrollment with health plans, many of which now require it for initial enrollment and recredentialing.   

Beyond CAQH Profile Creation

Once you have completed your profile, you will need to maintain it by attesting to information accuracy on a quarterly basis (every 120 days) and updating supporting documents within the CAQH system. You often will not be required to make any changes but be prepared to upload any newly acquired documents such as a medical/nursing license or liability insurance certificate when the copies on file with CAQH are expired. Again, if you prefer, PPM Partners can maintain your profile for the groups we enroll you with.

Any licensed medical provider that plans to see patients and bill insurance for their services, should have a CAQH profile. It is an essential credentialing tool that can ease the provider enrollment process for you.  

 

 

Carolyn Wilson

Provider Enrollment

 

References: 

(caqh1) https://www.caqh.org/