- Oct 25, 2023
- 5 min read

Filling Out a CAQH Application

What is CAQH?

CAQH ProView profiles are widely used in the healthcare industry for credentialing, directory maintenance, and other administrative processes that streamline the provider enrollment process with insurance companies and healthcare organizations. CAQH provides different types of profiles tailored to meet the specific needs of various healthcare professionals and organizations. Below are the four main CAQH profiles, each serving a distinct purpose:

1. CAQH ProView for Providers

Purpose and Use:

Primary Profile for Credentialing: This profile is designed specifically for individual healthcare providers, such as physicians, nurse practitioners, physician assistants, dentists, and other allied health professionals. It serves as a centralized repository of a provider’s credentials, including education, training, licensure, work history, practice locations, and more.
Streamlines Credentialing: Providers use this profile to enter and maintain their information, which can be accessed by insurance companies and other healthcare organizations for the purpose of credentialing, contracting, and network enrollment.
Updating and Re-Attestation: Providers are required to keep their profiles updated and must re-attest to the accuracy of their information every 120 days. This ongoing maintenance ensures that insurers always have access to current and verified provider information, reducing delays in credentialing.

Key Features:

Single Data Entry: Providers enter their data once and share it with multiple organizations, eliminating the need to fill out numerous forms.
Document Uploads: Providers can upload important documents, such as licenses, certifications, and malpractice insurance certificates, directly to their profile.
Secure Access: Only authorized entities, such as insurers or hospitals that the provider designates, can access the profile, ensuring data privacy and security.

2. CAQH ProView for Practice Managers

Purpose and Use:

Management of Multiple Providers: This profile is tailored for practice managers, group administrators, and office staff responsible for handling the credentialing of multiple providers within a practice, clinic, or healthcare organization.
Centralized Oversight: Practice managers can oversee and manage the credentialing information for all providers within their organization from a single account, streamlining the process of maintaining up-to-date profiles.
Batch Updates and Re-Attestation: The profile allows practice managers to make batch updates, such as changes to practice location or billing information, and to re-attest on behalf of all providers in the group, saving time and reducing administrative burdens.

Key Features:

Dashboard View: Practice managers have access to a dashboard that displays the status of all providers’ profiles, including pending tasks, re-attestation dates, and missing information.
Document Management: The profile supports the upload and management of required documents for each provider, ensuring that all necessary credentials are accessible and up-to-date.
Delegated Access: Allows practice managers to delegate access to other team members, ensuring that credentialing tasks can be distributed among staff.

3. CAQH EnrollHub

Purpose and Use:

Electronic Funds Transfer (EFT) Enrollment: EnrollHub is a CAQH solution specifically designed to facilitate Electronic Funds Transfer (EFT) enrollment for providers, allowing them to receive payments directly from health plans and insurers.
Simplified Payment Process: Instead of managing EFT enrollments individually with each health plan, providers can enroll once through EnrollHub, streamlining the process and reducing administrative complexity.
Enhanced Payment Efficiency: By centralizing EFT enrollment, EnrollHub helps providers improve their payment processes, reducing the time it takes to receive payments and minimizing errors associated with paper checks.

Key Features:

Single Enrollment: Providers can complete one EFT enrollment process to connect with multiple payers, eliminating redundant paperwork.
Data Security: EnrollHub is built with strong security measures to protect sensitive banking information and ensure that transactions are processed securely.
Real-Time Updates: Providers can make changes to their EFT information in real time, ensuring that payments are not disrupted when bank details change.

4. CAQH DirectAssure

Purpose and Use:

Maintaining Accurate Directory Information: DirectAssure is a CAQH service that helps providers keep their directory information up-to-date with health plans, ensuring that patients can easily find accurate provider details when searching for care.
Compliance with Network Adequacy Standards: Accurate directory information is essential for health plans to comply with regulatory requirements related to network adequacy, access to care, and patient navigation. DirectAssure helps meet these standards by ensuring timely updates to provider information.
Reduces Administrative Burden: By centralizing updates, providers only need to enter changes once, and the updates are automatically shared with participating health plans, reducing the burden of manually contacting each plan separately.

Key Features:

Streamlined Updates: DirectAssure allows providers to confirm or update their directory information quickly, including practice locations, office hours, and availability to accept new patients.
Automated Notifications: Providers receive automated notifications when updates are needed, ensuring their information remains current and accurate in health plan directories.
Provider Visibility: Maintaining accurate information helps providers stay visible to patients searching for in-network care, potentially increasing patient volume and satisfaction.