CAQH Credentials – The Whys and Hows of CAQH Credentials for Medical Providers

Many insurance companies request or require CAQH credentials as a way to join or register with their provider network. What is a CAQH application, what information is required to complete the application, how long does it take and how should I apply are some of the questions that arise.

In the past, if a provider wanted to join an insurance company, he or she asked for a provider application package and was sent it. Each request was different from the next. If you want to participate with 12 insurance companies, you may need to complete 12 reference applications.

The CAQH reference process is designed to provide a universal reference system for medical service providers seeking to join an insurance company’s network. CAQH is a non-profit organization created to simplify healthcare administration. By completing the CAQH application, a provider now has their information available for an insurance company to check online for reference purposes.

The CAQH request is quite long and complicated, but will become necessary over time, as we saw with the NPI numbers. Many companies now require a completed CAQH application for both credentialing and re-credentialing and no longer offer their own application. We provide a service to actually do the CAQH application for providers. You can get more information about getting help with your CAQH application through our website link below.

The CAQH referral process works well for new providers just starting out in the field. They can apply to many insurance companies by completing just one application. They then contact the insurance companies they are interested in and the insurance company can access the provider’s information online on a secure site.

The information required to complete the application includes name, address, practice location, tax number #, npi #, education, malpractice insurance, references, hospital affiliations and much more.

The application can be completed online or you can have a paper copy 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 go. You create a login name and password so that you can come back later.

Upon completion, the applications undergo an audit to ensure that all necessary information is complete. Supporting documentation must then be faxed to a secure database. You will then be notified by e-mail or fax that your application is complete.

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

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For help with the CAQH reference process, visit our Solutions Medical Billing website

Coryright 2007 – Alice Scott