CAQH Credentialing: Why Your Practice Needs Reliable Credentialing


CAQH is a massive and secure central database of credentialing information that healthcare providers can access free of cost to register with payers. Physician credentialing is the process of getting a provider credentialed with government and commercial insurance companies. Comprehensive Physician Consulting can help you get credentialed with insurers and update your information when required.

Why do you need hassle-free, efficient credentialing & enrollment support?

The CAQH credentialing process is more efficient when you have the right support. Physicians starting a medical practice need to be credentialed and contracted by insurance companies in their geographical area in order to bill for their services. Physicians who have already registered with payers need to keep their status up to date. All the information needed for credentialing can be uploaded and kept updated on CAQH (Council for Affordable Quality Healthcare), an online data repository of credentialing data that insurance companies can access.

What is CAQH Credentialing?

CAQH Credentialing

In today’s insurance coverage led world, insurance companies need to maintain a provider directory listing of all in-network providers for their plans. They require information about providers’ qualifications to ensure that they meet specific internal requirements for contracting with them.

CAQH is a massive and secure central database of credentialing information that healthcare providers can access free of cost to register with payers. CAQH aims to simplify the physician credentialing process by collecting credentialing information on healthcare providers and making that information available to health plans and other healthcare entities.

For CAQH credentialing, your practice needs to self-report demographics, education, training, work history, malpractice history, and other relevant credentialing information. Health plans and other healthcare entities pay to access this repository and collect and verify credentialing information in order to register a new provider/practice in their network. For payer re-credentialing, your practice needs to keep your information with CAQH up to date.

Have you updated your provider information on the CAQH portal?

CAQH is a non-profit organization set up by the leading national insurance companies to streamline the administrative processes between your practice, payers and patients. It is a voluntary online portal. However, 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 your practice submits the required information, CAQH requires an attestation of the information after four months. A notification is sent 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 do not respond to the re-attestation notice, your profile becomes inaccessible. 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 or possible loss in rate benefits.

Get Hands-On Professional Credentialing Help in New Jersey and Central PA

Comprehensive Physician Consultants is a leading provider of revenue cycle management solutions for medical and dental practices. We’re local. We become members of your team. The benefits of using our expert credentialing services include:

  • Faster claims processing and reduced denials
  • We ensure your data with payers is up to date with ongoing maintenance
  • We provide re-attestation support
  • You get timely reporting
  • We eliminate voluminous enrollment paperwork
  • Your practice staff can focus on patient care
  • Your practice saves money

Our credentialing experts have extensive experience working with leading insurance companies such as Aetna, Cigna, Blue Cross Blue Shield (BCBS), Humana, Optum, United Healthcare, and more. Outsourcing your CAQH credentialing task to us can help you complete the enrolment quickly, maintain your CAQH profile, and receive timely, appropriate reimbursement.

The experts at Comprehensive Physician Consulting are ready to help you get started with your CAQH registration process. To learn more, contact Leslie at 856-888-7796 or visit us online HERE.