Professional Support to Complete and Maintain Your CAQH profile
CAQH Credentialing Services
The Council for Affordable Quality Healthcare (CAQH) is an electronic solution that simplifies and expedites provider data collection for physician credentialing. CAQH profile creation is the first step in the provider credentialing application process.
The revenue cycle management process begins with provider credentialing. Healthcare providers need to be affiliated with an insurance company’s network in order to receive reimbursement for services provided to patients enrolled in a health plan offered by that company. Government and commercial health plans use CAQH credentialing to verify the information provided by physicians and other healthcare providers to ensure they qualified.
Outsource Strategies International (OSI) provides end-to-end revenue cycle management solutions for all specialties. We can guide and support you in every step of the CAQH credentialing process profile creation and registration process, including reattestation. Keep your data accurate and up-to-date with insurance carriers!
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How to Create a CAQH Profile
CAQH gathers information about the provider so government and commercial carriers can access it. CAQH ProView is a software in which healthcare providers can self-report professional and practice information to health plans and other healthcare organizations for the enrollment process. This resource allows providers to enter, submit, and store all credentialing data electronically for participating organizations.
The CAQH provider enrollment and credentialing process involves several steps that providers must complete for every health plan they want to enroll with. To begin, providers should have a complete and up-to-date profile in the CAQH system.
Have Your Information and Scanned Documents Ready
- Basic personal information
- Practice location information (practice name and type, address, contact information)
- Current CV – make sure it is complete and correct
- Education and training history
- Licensing and certificates
- Medical group and hospital affiliations
- Board certifications
- Disclosure and malpractice history
- Malpractice insurance information
- Work history and references
Our CAQH Registration and Profile Creation Services
The basic steps to create a CAQH profile are as follows:
1. Register and Get your CAQH Provider ID Number
New CAQH ProView users may either self-register or be added to the system by an organization, and will receive an email from CAQH ProView with a unique CAQH Provider ID and a link to create a CAQH ProView account. Information required to set up a CAQH ProView account includes: name, provider type, primary practice state, birthdate, email address, and at least one personal identification number.
To complete your CAQH registration:
- Click on the link sent to you (https://proview.caqh.org/pr)
- Click “Register.”
- Enter CAQH Provider ID Number
- Provide your authentication data (SSN, DOB, etc.)
- Create a username and password
- Answer three security questions
- Accept the Terms of Service
After you create your account, you will receive confirmation that your CAQH ProView registration was successful.
2. Complete all Application Questions
Go to “Manage Information” and enter the requested information within each section. Data that is the same for multiple providers would need to be entered only once.
3. Review the Data
After data entry is complete, review your profile and make any required corrections / changes to your information.
4. Authorize Access to Your Information
Next, authorize who has access to your information. CAQH offers two options: you can authorize any insurance company that indicates they would like to have you on their panel, or manually select which insurance companies you want to be able to access your profile.
5. Attest to your Data Profile
Perform a final review of your data profile and complete it by attesting to its accuracy. A confirmation on CAQH attestation will be sent via email to you within approximately 48 hours after all documents have been received and approved.
If corrections are required or there are missing or expired documents, you will need to correct all the errors in order to complete the re-attestation. Re-attestation is required on a quarterly basis in CAQH ProView. This is necessary to ensure your data is up-to-date and accurate for health plan use.
6. Upload Supporting Documentation
The final step to complete your profile is to upload relevant supporting documents on CAQH ProView. Upload each document separately and make sure to select the proper document name or document type when uploading each one.
If fixes are required or there are missing or expired documents, you need to correct all the errors in order to complete the re-attestation. Re-attestation is required on a quarterly basis in CAQH ProView. This is necessary to ensure your data is up-to-date and accurate for health plan use.
We can deal with all your insurance credentialing concerns, the major step in your practice’s revenue cycle management.