What is CAQH Enrollment?

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Basics of CAQH

CAQH stands for ‘Council for Affordable Quality Healthcare’. It is essentially an online database that stores provider information. Providers grant access to their information to insurance companies. Instead of calling your office for your work history or a copy of your medical license, insurance companies can go in and pull it directly from your file. 90% of the National Health Insurance Companies use CAQH and it is a prerequisite for their enrollment process. Not having a completed CAQH application will delay your enrollment with the insurance companies. Furthermore, this will prevent you from getting reimbursed for your services.

Registering with CAQH

Have all of your documents ready for uploading and your CV updated. You’ll need your license, DEA (and controlled substance cert if applicable), malpractice certificate, CV, W9, board certificate, hospital privileges (if applicable), and your diplomas.
Make sure you have three professional references as these are required for your application.
If you’re starting a practice, you’ll also need information about your new entity including the following: legal entity info, tax id, address (including payment and correspondence if they are different), billing company info if outsourcing, credentialing contact, billing contact, hours of operation, phone/fax, GROUP NPI, etc.
Once you feel like you have everything ready for submission, visit: https://proview.caqh.org/PR/Registration/SelfRegistration
Once you’ve made it through to the end of the application, you now need to grant the payers access to your information. Before they can do this, you must submit a signed attestation document provided by CAQH. This is you verifying that you’ve submitted accurate information and telling the payers that your application is ready for review.
Once you sign and date the release/attestation, you want to make sure and remember to upload the document through their document
Be sure to save your CAQH ID #, user ID, and password. Keep this in a safe place and remember to check it every ninety days to ensure nothing needs your attention. CAQH is supposed to email you or whoever you put as the credentialing contact but you don’t want to rely on their reminder.

Required Information for CAQH

Detailed practice information helps ensure that participating health plans, hospitals, and other healthcare organizations can obtain all the information they need without having to conduct any follow-up with physicians or other healthcare providers. Information you will be asked:

Basic Personal Information
Education and Training
Medical /Professional school
Graduate school
Internships and residencies
Fellowships and preceptorships
Teaching appointments
Specialties and Board Certification
Practice Location Information
Practice name and type
Address and contact information
Billing, office manager, and credentialing contact
Services, certifications, limitations, and hours of operation
Partners and covering colleagues
Hospital Affiliation Information
Malpractice Insurance Information
Work History and References
Disclosure and Malpractice History

Required Documents for CAQH

Following is a list of documents you will need to complete your application:

IRS Form W-9(s)
Drug Enforcement Administration (DEA) Certificate
Controlled and Dangerous Substances (CDS) Certificate
State medical license(s)
Various identification numbers (UPIN, Medicare, Medicaid, etc)
Malpractice insurance policy(ies)

Worried about getting credentialed/enrolled with insurance companies? Hopefully, this article gave you information on CAQH enrollment. PrimeCare MBS offers comprehensive practice start-up services, insurance credentialing/contracting, and credentialing maintenance packages to fit every budget. For more information about our credentialing services, feel free to call PrimeCare MBS at 407-413-9101 or write to us at sales@PrimeCareMedicalBilling.com

What is CAQH Enrollment?