CAQH: Top 5 things you need to know
Top 5 things to know about CAQH
- What Is CAQH?
- Do I need a CAQH number?
- How do I know if I have a profile or need to apply?
- I’m Leaving my current Job, do I need a new CAQH?
- Should I manage my own CAQH?
What is CAHQ?
CAQH stands for Council for Affordable Quality Healthcare. It’s an information repository for health care providers that houses all the providers credentials such basic info, full name, DOB, address, phone, NPI, education, license’s, DEA, training, Specialties, work history, practicing locations, TIN’s and copies of all these documents need to be uploaded to the site. Basically, a detailed CV. Providing a set of systems that interface with health care systems to validate and verify credentials of health care providers to streamline and safeguard transmission of confidential information. Payers can be granted access to view your data when trying to get join a network and get contracted.
Do I need a CAQH number?
If you are a provider accepting insurance plans, YES, you will need to have your CAQH. All insurance payers require the CAQH when wanting to join a network to get contracted
Any provider can apply for a CAQH number and profile in case at some point of your career you choose to be contracted with insurance payers.
Your CAQH number is used for Insurance panels for credentialing electronic remittance advice and practice management.
This need to be attested every 120 days just to verify that this is info is accurate and there has been no changes (all changes and updates must be reported)
How do I know if I have a profile or need to apply?
This is frequently asked question by our partners. Often times the practice that you work for will have a team that will create and/or manage your CAHQ profile for you.
To find out if you have a CAQH profile you can go to the CAQH website for assistance in locating your profile information.
How to apply:
In order to apply, you first need an individual provider type 1 NPI. Once you have that you can go to the website and start the process.
If you are a new provider, or new to accepting insurance, you can go to CAQH log in page to register.
If you need Contracting and credentialing services and not sure where to start regarding your CAQH, we recommend contacting us prior to taking these steps so we can partner with you and walk you through the process in order to ensure the process is simple for you.
I’m Leaving my current Job, do I need a new CAQH?
It is important to know that you get one CAQH profile for the lifetime of your career. So the short answer is, No. you will not need to apply for a new CAQH number.
However, when you leave a practice, you will need to gain access to your profile in order to reflect accurate information.
The good news is that, even if you did not create your profile on your own, you can still follow the link above we provided to look up your profile and gain access to update your information.
When you update your information, it is recommended that you update your practice location versus removing the old information in order to show payers that your information has been validated before which could shorten your overall contracting review process.
Should I manage my own CAQH profile?
Regardless of who created the account for you, your CAQH profile belongs to you!
The provider is responsible or if he has a rep with a precative or outside of that. It is common for providers not to manage their own CAQH profile, and that is okay! We do recommend that you at least keep track of your account information.
It is important to remember that since your CAQH is used for payer re-credentialing and updates, this is not a set it and forget it database. It requires maintenance on your part whether you choose to manage it yourself or task one of your staff to manage for you.
This one number will be your second form of an identification number for credentialing and contracting (remember this needs to be maintained. If you don’t attest every 120 days your account will become incomplete and you will not be able to seek out credentialing, contracting and or re-credentialing with insurance until your account is brought up to current). You can even potentially be dropped from ins. if the CAQH is not attest every 120 days. Your NPI would be your first form.
Typically, our credentialing team will maintain our partners CAQH and accounts for them to ensure it is properly maintained to streamline the process on their behalf, once they leave it is no longer our responsibility.
CAQH RECAP:
We hope you found this article helpful and answered your top questions regarding CAQH. In case you forget everything you just read, here is a quick recap of what you will want to remember:
- You only get 1 CAQH number for the life of your career
- It is not a set it and forget it database
- CAQH is needed for Insurance Credentialing
If you have any questions about CAQH or how to partner with us for Contracting and Credentialing call us directly at 855-936-6023 or fill out a request form on our website.
If you missed our post from last week you are going to want to click here to read about PAD awareness and grab your free marketing resources to use!
Have a wonderful weekend and check back next week for more information from your favorite Billing Partners!
