Being a medical provider you probably have come across the term CAQH credentialing. Let’s understand what it means and how do you complete a CAQH profile accurately.
CAQH expands to Council for affordable quality healthcare and is an online consolidated database that contains information about providers. It is through this portal only that providers grant insurance payors access to their information to contribute to the efficiency of the entire acquisition process.
Almost 90% of the National Health companies in 2019, employ CAQH as their preferred primary database to obtain provider information. This percentage includes over 900 health plans, hospitals, and healthcare organizations.
CAQH was set up with a simple objective in mind- simplifying the data gathering process with a consolidated information database for healthcare providers and insurance companies. Without this facility, a physician would need to submit multiple applications with multiple companies which is altogether a very time-consuming process. CAQH insurance credentialing, however, simplifies the process to a great extent by reducing the time taken for the applications to be processed.
Another important benefit that CAQH offers is information security. The CAQH database resides in a secure network. Information within this database flows to and fro through redundant firewalls. Strict protocols like secure internet access, passwords, electronic signatures, and encrypted SSL certificates ensure that provider data is only accessible to authentic users.
Providers can store their information for no cost, however, insurance plans and other payors are required to pay a certain amount to access the same.
Completing the CAQH profile is a crucial step in delivering healthcare services without much interruption from the healthcare regulatory authorities.
There are three simple steps to get registered.
There’s a chance that the insurance network that a provider wants to get into uses CAQH as its provider information database. Consider checking on the list of participating organizations at the CAQH website to ascertain the same. If the insurance provider you are getting in-network with is using CAQH, you will be receiving a CAQH ID as well.
Or, you can also consider self-registration on the CAQH portal to get a CAQH number before even applying for credentialing. This number is significant and comes in handy while re-attesting the information.
To get your CAQH profile done on time, it is recommended that you have all the information at hand. The following is the information that you would need.
Demographics, Education and Training particulars, Specialties and Board Certificates, Malpractice Insurance Information, work history, and some references.
Other than the above information, here is some material that you would require.
CV or resume, malpractice or insurance policies, drug enforcement administration certificate, state licenses, W9s, all applicable ID numbers.
The information on your documents including your CV is required to be error-free. It is necessary that you use the dates in the prescribed format. Violating these little terms may lead to application rejections and you may need to re-apply.
Once you arrange all the information and documents needed to complete the CAQH profile, it is time to complete it. Taking the process online would help you do it faster compared to the traditional paper-laden way, which is simply too chaotic and less efficient.
The CAQH profile is not necessary to be completed in one sitting. It can be saved to be completed on some future date. Once you have the required information and everything is filled, the website will ask you for a final review and attestation to its validity.
Once the application is complete, you will have to choose who has access to it. With two options being served to you by the CAQH portal, you can choose to allow access to the insurance companies you like or manually select the panels that you would like to have access to your information.
To complete the CAQH profile accurately, providers would need a third-party credentialing partner like Bikham. With the years of experience in handling the complex CAQH insurance credentialing, we can make your application process much convenient and seamless.