CAQH Credentialing – The Why and How of CAQH Credentialing for Medical Providers

Many insurance carriers are requesting or requiring CAQH credentialing as a way to join or recredential with their provider network. What is a CAQH application, what information is needed to complete the application, how long does it take and how do I apply are a few of the questions that arise.

In the past in order for a provider to participate with an insurance carrier he or she would ask for and be sent a provider application packet. Each application was different than the next. If you wanted to participate with 12 insurance companies, you might have to complete 12 credentialing applications.

The CAQH credentialing process was designed to provide a universal credentialing system for medical service providers who wish to join an insurance company’s network. CAQH is a non profit organization formed to simplify healthcare administration. By completing the CAQH application, a provider now has his or her information available for an insurance company to check online for credentialing purposes.

The CAQH application is quite lengthy and involved but it will in time become necessary as we saw with the NPI numbers. Many companies are now requiring a completed CAQH application for both credentialing and re-credentialing and no longer offer an application of their own. We offer a service of actually doing the CAQH application for providers. You can get more information on help with your CAQH application at our website link below.

The CAQH credentialing process works well for new providers just starting in practice. They can apply to many insurance companies by completing only one application. They then would contact the insurance companies they were interested in and the insurance company can access the provider’s information online at a secure site.

The information required to complete the application consists of name, address, practice location, tax id#, npi #, schooling, malpractice insurance, references, hospital affiliations, and much more.

The application can be completed online or you can request a hard copy be mailed to you. A printed copy would be completed and returned to CAQH. When working on an online application it is not necessary to complete it in one setting. You create a login name and password so you can return later.

Upon completion the applications undergo an audit to make sure all the necessary information is complete. Supporting documentation must then be faxed to a secure database. You are then notified by email or fax that your application is complete.

Once your application is complete, participating health plans and hospitals that you designated during the application will be automatically notified that your application is available for them to view.

For help with the CAQH credentialing process, check out our website Solutions Medical Billing

Coryright 2007 – Alice Scott