Why CAQH is Required for Provider Credentialing?

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Why CAQH is Required for Provider Credentialing?
Credentialing is a systematic approach to the
collection and verification of a healthcare
providers professional qualifications. The
qualifications that are reviewed and verified
include, but are not limited to, relevant
training, licensure, certification and/or
registration to practice in a health care field,
and academic background. Insurance credentialing
is the process of becoming affiliated with
insurance companies to ensure healthcare
providers can accept third-party
reimbursement. There are a lot of misconceptions
about CAQH, what it is, what it does, and why
its used.  Were going to answer these questions
and tell you how to register with CAQH. CAQH is
an online data repository of credentialing data.
Provide credentialing using CAQH refers to the
process of practitioners self-reporting
demographics, education and training, work
history, malpractice history, and other relevant
credentialing information to create an online
credentialing profile for insurance companies to
access. Electronic access to this information is
meant to reduce the burden of paperwork by
eliminating much of the paper-based enrollment
process involved with payor network enrollment
and facility privilege applications.
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Why CAQH is Required for Provider Credentialing?
What is CAQH? CAQH functions as a giant database
that insurance companies and credentialing
companies can pay to access. CAQH does not submit
applications to insurance companies or complete
the credentialing process but they do play a
vital role in this process. Think about your
license, malpractice policy (COI), DEA
certificate or anything else that routinely
expires without your intervention. These
documents are needed by the insurance companies
and rather than providing each payer an updated
license, you can upload this document into CAQH,
attest to its accuracy and grant the payers
permission to access the file. Not all plans
have access to CAQH so its important to not
assume all payers will have your information once
your profile is built. Most local/regional health
plans do not access it and none of the government
payers use it. Note that CAQH is not used by
Medicare, Medicaid, or Tricare. CAQH and
Credentialing
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Why CAQH is Required for Provider Credentialing?
CAQH is used for initial credentialing and for
payer re-credentialing. This means that its not
a set-it-and-forget-it database but requires
maintenance on your part. When youre first
getting credentialed with health plans, sometimes
payers will use your CAQH application/profile and
export it into their system. In order to
accomplish this, the payer has to be authorized
and will often request your CAQH id number over
the phone, online, or via email. Once youre up
and running which includes getting contracted the
payer will likely use CAQH to keep your file up
to date. This is why remembering to re-attest
every 90 days and keep your documents updated is
so important. Importance of CAQH CAQH is
required by many insurance companies so you
really dont have much of a choice. There are
exceptions to this as a handful of states have
their own system which functions much like CAQH. 
However, even if your state has its own system,
it still makes sense to register with CAQH as
some of the national plans reluctantly use the
state system but ultimately prefer CAQH. In
addition to being a requirement in most states,
it improves efficiency by cutting down the number
of redundant applications or requests for info
that have to be handled.
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Why CAQH is Required for Provider Credentialing?

• Registering with CAQH
• While youre not required to complete the CAQH in
  one sitting (that could take hours), it is better
  to have all the required information and
  materials ready ahead of time to speed up the
  process.
• Heres some information youll need to complete
  the CAQH
• Basic personal information
• Education and training
• Specialties and board certification
• Practice location information, including the
  practice name and type, address, contact
  information, services, certifications,
  limitations, hours, partners, covering
  colleagues, billing, office manager, and
  credentialing contact
• Malpractice insurance information
• Work history and references
• Disclosure and malpractice history
• CV or resume
• Malpractice insurance policy(ies)
• W-9(s)

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Why CAQH is Required for Provider Credentialing?

• State license(s)
• Various ID numbers (UPIN, NPI, etc.)
• Drug Enforcement Administration (DEA) certificate
  (if applicable)
• Controlled and Dangerous Substances (CDS)
  certificate (if applicable)
• Once you feel like you have everything ready for
  submission, visit https//proview.caqh.org/PR/Reg
  istration/SelfRegistration
• Once youve made it through to the end of the
  application, you now need to grant the payers
  access to your information. Before they can do
  this, you must submit a signed attestation
  document provided by CAQH. This is you verifying
  that youve submitted accurate information and
  tells the payers that your application is ready
  for review.
• Once you sign date the release/attestation, you
  want to make sure and remember to upload the
  document through their document
• Be sure to save your CAQH ID , user id, and
  password. Keep this in a safe place and remember
  to check it every ninety days to ensure nothing
  needs your attention. CAQH is supposed to email
  you or whoever you put as the credentialing
  contact but you dont want to rely on their
  reminder.
• Struggling with credentialing complexities?

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Why CAQH is Required for Provider Credentialing?
Let Medical Billers and Coders (MBC) simplify the
process for you! Our expertise ensures accurate
credentialing and seamless insurance
enrollment. Reach out to us today
at 888-357-3226 or email info_at_medicalbillersandcod
ers.com to streamline your credentialing
process. FAQs Q What is credentialing in
healthcare? A Credentialing is the process of
verifying a healthcare providers qualifications,
including training, licensure, and
certifications, to ensure they meet industry
standards. Q What is CAQH, and why is it
important? A CAQH is an online database where
healthcare providers can store credentialing
data. It simplifies insurance enrollment and
reduces paperwork for credentialing and
re-credentialing. Q Does CAQH handle
credentialing directly with payers?
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Why CAQH is Required for Provider Credentialing?
A No, CAQH does not submit applications to
payers but provides a platform for storing and
sharing credentialing information with authorized
insurance companies. Q How often should I
update my CAQH profile? A You must re-attest
your CAQH profile every 90 days and keep all
documents updated to avoid delays in processing
by payers. Q Is CAQH required by all insurance
providers? A No, not all payers use CAQH. Some
regional plans and government payers
like Medicare and Medicaid require separate
credentialing processes.