Have you updated your provider information on the CAQH portal basis the last CAQH re-attestation notice received? Recently, one of our client’s lost contracts due to NO response on CAQH.
CAQH, or the Council for Affordable Quality Healthcare, is a non-profit organization set up by the leading national insurance companies to streamline the administrative processes between payers, physicians, and patients. It is a voluntary online portal that physicians and other healthcare professionals (in all 50 states and the District of Columbia) can access to update their information and documents in a secure database. The data is accessible to participating insurance companies for evaluating physicians for credentialing. The CAQH portal eliminates the paperwork involved in credentialing with multiple payers. And it helps healthcare organizations to obtain the information they need for credentialing without having to follow up.
Once a provider has submitted their information on the CAQH ProView, the CAQH requires an attestation of the information after four months. A notification is sent to the provider to verify that the information is still correct and comprehensive. The update of this information is accessed by other participating organizations (with whom the provider is contracted). These organizations access the CAQH ProView profile during their respective re-credentialing cycles.
CAQH update is not mandatory for medical practices. However, if you fail to respond to the notice for re-attestation, your information is no longer accessible – not even to the healthcare organizations and health plans that you have authorized to access your data. So, if the CAQH participating organization is re-credentialing you, they will not be able to verify your details, leading to a delay or denial in credentialing. Once credentialing with payer lapses, you stand to lose the rate benefits you had in the erstwhile contract with the payer.
Therefore, ensuring the complete accuracy of your CAQH ProView profile is vital. To help you achieve this, here is a summary of the steps involved in using CAQH ProView.
For new users:
- To register with CAQH ProView, go online to https://proview.caqh.org/pr
- Click “Register.”
- Enter the CAQH Provider ID Number and your authentication data (e.g., SSN, DOB, etc.).
- Create a username and password.
- Choose and answer three security questions. Acknowledge the Terms of Service.
- Complete the Application and Review Data.
- Authorize Access to Your Information Only you can authorize who has access to your information.
For existing users:
- Log in to your existing account.
- Select “Review” from the top navigation bar to review your profile, see if there are new fields for you to complete, and correct any required fixes to your information
- If you want to access a specific section, select “Manage Information” from the top navigation bar.
- Proceed to “Next Steps — All Users” to verify your data entry and attest.
Read the Provider Quick Reference Guide for more information.
Are you on top of your credentialing game? Read our post, 9 Tips on Medical Credentialing to Boost Revenues.
Feel free to contact us for additional queries you may have on medical credentialing or CAQH updates.