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CAQH Explained

What is CAQH?

CAQH is a secure online platform allowing providers to enter and update their professional and practice information and share it with health plans and other healthcare organizations. It's essentially an in-depth resume that lists the details about an individual provider. CAQH is not needed for clinics or groups. The clinic information is entered within the respective provider's account.

Filling out a CAQH can benefit you as a provider in two ways.

  1. Initial provider enrollment. After a provider submits an application to an insurance company for credentialing, the insurance company will use CAQH to verify and validate the provider. The provider must ensure the information on their CAQH is current and correct before applying. If the information on the application and CAQH doesn't line up, it can cause delays and denial of the application. 

  2. Maintaining a provider's enrollment with an insurance company. Once a provider's credentialing is approved and they are enrolled with an insurance company, they will still need to monitor their CAQH information. License(s) malpractice insurance, clinics providing services, and more must be updated as required. In addition, the CAQH profile needs to be attested every 120 days.

Please maintain the information to prevent the provider from experiencing billing issues and losing their contract with an insurance company. Commercial insurance companies are constantly updating their standards and requirements. One requirement that has been strictly upheld is that the provider must maintain their information on CAQH or risk losing their contract.

With eleven significant sections to fill out and even more subsections within those major sections, entering all the information needed can initially seem daunting. However, once it's filled out, updating the information as required is easier. Each provider should know how CAQH works and how it can affect their professional career. CAQH offers support to educate providers and assistance in how information should be entered.

If a provider wants to enroll with an insurance company, choosing a credentialing specialist who understands the nuances and how to utilize CAQH best is essential. 

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