CAQH FREQUENTLY ASK QUESTIONS

 

What is CAQH?

CAQH ProView is the trusted source and industry standard for collecting provider data used in credentialing. In the future, this data can also be used for claims processing, quality assurance, emergency response, member services and more.

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What is CAQH ProView?

CAQH ProView is an online provider data-collection solution. It streamlines provider data collection by using a standard electronic form that meets the needs of nearly every health plan, hospital and other healthcare organization.

CAQH ProView enables physicians and other healthcare professionals in all 50 states and the District of Columbia to enter information free-of-charge into a secure central database and authorize healthcare organizations to access that information. CAQH ProView eliminates redundant paperwork and reduces administrative burden.

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What is CAQH and credentialing?

The CAQH Universal Credentialing Data Source is designed make the credentialing process easier for providers by gathering data in a single repository that may be accessed by participating health plans and other healthcare organizations. The Data Source enables providers to easily update their information.

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What does the CAQH stand for?

Council for Affordable Quality Healthcare

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.

Is CAQH required?

 

Are all physicians and other healthcare professionals required to use CAQH ProView? No. Participation in CAQH ProView is voluntary. Some health plans and other healthcare organizations have requested that their network providers use CAQH ProView starting with their next re-credentialing event

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What is a CAQH profile?

CAQH ProView is the healthcare industry's premier resource for self-reporting professional and practice information to health plans and other healthcare organizations. Through an intuitive, profile-based design, you can easily enter and maintain your information for submission to your selected organizations.

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Are all physicians and other healthcare professionals required to use CAQH ProView?

No. Participation in CAQH ProView is voluntary. Some health plans and other healthcare organizations have requested that their network providers use CAQH ProView starting with their next re-credentialing event. Click here for a list of CAQH ProView-participating organizations or call the CAQH ProView Support Desk at 1-888-599-1771. Provider relations staff can also provide this information.

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How do providers access CAQH ProView?

Providers can register online at https://proview.caqh.org/pr, or will receive registration instructions once a healthcare organization notifies CAQH that the provider needs to access the database. Once registered, use the CAQH Provider ID and password to access CAQH ProView.

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How do physicians and other healthcare professionals complete the CAQH ProView data collection process

Completing the online form requires five steps:

• Register with CAQH ProView.

• Complete the online application and review the data.

• Authorize access to the information.

• Verify the data and/or attest to it.

• Upload and submit supporting documents.

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Why does CAQH ProView ask for such detailed provider and practice information?

Detailed practice information helps ensure that CAQH ProView 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. The form's broad scope also ensures that participating organizations can better maintain and improve provider directories and data systems.

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Do providers need to complete their entire profile?

Yes. Providers must complete all profile questions; however, the system is designed to allow you to complete your profile over time. The CAQH ProView profile will present questions that are relevant to a particular specialty, provider type and practice location(s). You can stop any time, save what you have completed, and return later to finish the process. The entire profile must be completed prior to your verification of its accuracy, and before the participating health plans you have authorized can access it.

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Why should providers respond to CAQH re-attestation notices?

After providers complete their CAQH ProView applications, CAQH will notify them every four months to re-attest that all information is still correct and complete. This enables a provider’s contracted participating organizations to access CAQH ProView profile information based on their different re-credentialing cycles. While it is highly recommended that providers complete the re-attestation process in a timely manner, it is not required. In the event a CAQH participating organization needs to access a provider’s information, it will not be accessible until the provider completes re-attestation process.

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Does the provider data profile created in CAQH ProView meet the NCQA requirements for credentialing application content in CR3, Element C?

Yes, the NCQA website clarifies that CAQH ProView system data meets the requirement in CR3, Element C, and is acceptable in either electronic or PDF format. There is no automatic credit for the application. NCQA reviews CAQH ProView output against the appropriate elements.

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Can any organization access a provider’s data?

No. The provider controls which organizations have access to the information. When completing the CAQH ProView profile, providers indicate which healthcare organizations and health plans are authorized to access the data.

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Do physicians and other healthcare professionals need to notify CAQH ProView participating organizations that they have completed their CAQH ProView profile?

No. Organizations authorized to view completed data will automatically be notified.

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Who can I contact for help or if I have any questions about CAQH ProView?

Contact the CAQH Help Desk: 

Providers: Log in to CAQH ProView and click the chat icon at the top of any page or call: 888-599-1771.

Participating Organizations: Email accounthelp@proview.caqh.org or call: 888-600-9802.

Help Desk hours are:

Monday – Thursday: 7 AM – 9 PM (ET)
Friday: 7 AM – 7 PM (ET)