Open graph CAQH | The Importance of CAQH | STATMedCare Payor and Physician Enrollment and Credentialing

An important aspect of provider enrollment and credentialing is CAQH set up and maintenance. With rising healthcare costs, enrolling in CAQH can help relieve some of the healthcare administrative costs. A benefit of enrolling in the CAQH database/registry is having your credentials and demographic information in a centralized location. However, the initial set up of the registry is very complex and comprehensive. After being a provider is enrolled, the credentialing process becomes easier and all the provider data is easily accessible by participating payor plans.

What is CAQH?
CAQH, or Council for Affordable Quality Health Care, is a non-profit alliance consisting of health plans and related healthcare associations. The council’s primary goals are to reduce healthcare administrative costs, simplify healthcare administrative processes, and increase the quality of healthcare for patients.

The Universal Provider Database (UPD), located within CAQH, is also called CAQH ProView. It allows the providers to update their information, add demographic information, and upload their credentials. The profiles are created at no cost to the provider. By enrolling in CAQH, over 800 participating organizations can access this information for credentialing, network directories, claims administration, and more.

The Process
The CAQH ProView (UPD) process involves 5 different steps:

1. Register with CAQH ProView;
2. Complete the online application and review the data;
3. Authorize access to the information;
4. Verify the data and/or attest to it; and
5. Upload and submit supporting documents.

When completing a CAQH profile, providers must indicate which organizations and health plans have the authorization to access their data. Enrolling in CAQH is voluntary, but participating in the registry makes it convenient and easy for payors and providers to access the information that they need for credentialing purposes.

If you need assistance in the enrolling and/or maintenance of the CAQH database and registry, or have a credentialing, payor enrollment, rate negotiation, or licensing need, please contact us for more information!

 

Joy Ortiz is the Marketing Specialist for STAT MedCare, LLC, a U.S.-based, national provider of credentialing, payor enrollment, rate negotiation and other credentialing related services.