Guidance on CAQH Application Process

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Guidance on CAQH Application Process
Before we dive into the CAQH application process,
lets understand what is CAQH and why creating an
account in CAQH is required for provider
credentialing. What is CAQH? CAQH is required
for healthcare provider credentialing because it
provides a centralized database of provider
information that can be accessed by multiple
healthcare organizations. CAQH (Council for
Affordable Quality Healthcare) is a non-profit
alliance of health plans and related
organizations that promotes the simplification of
healthcare administration. Many health plans and
healthcare organizations require providers to be
registered with CAQH and maintain their accurate
and up-to-date information. CAQH provides a
centralized database of provider information that
can be accessed by multiple healthcare
organizations. By using the Universal Provider
Data source (UPD), healthcare organizations can
verify the credentials and qualifications of
providers in a more efficient and accurate
manner. This eliminates the need for providers to
submit the same information to multiple
organizations and reduces the administrative
burden on both providers and healthcare
organizations.
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Guidance on CAQH Application Process
CAQH Application Process   CAQH offers a variety
of healthcare-related solutions, including a
universal provider credentialing service known as
CAQH ProView. The CAQH ProView application
process is used by healthcare providers to
centralize and streamline the credentialing and
contracting process for participation in
healthcare networks, plans, and
organizations. The CAQH application process
involves several steps, including Registering
for an account Healthcare providers must create
a CAQH ProView account before they can start the
application process. To do this, they need to
visit the CAQH website and click on the
Register button. They will then need to provide
some basic information such as their name, email
address, and NPI (National Provider Identifier)
number. Completing the application Once
registered, providers can begin filling out the
CAQH ProView application. This involves answering
a
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Guidance on CAQH Application Process
series of questions and providing supporting
documentation to verify their credentials, such
as education and training, work history, licenses
and certifications, malpractice insurance, and
more. Reviewing and submitting the
application Once the provider has completed the
application and uploaded all required
documentation, they will need to review the
application to ensure everything is accurate and
complete. They will then need to electronically
sign the application and submit it to CAQH for
review. Credentialing verification After
submitting the application, CAQH will review and
verify the providers credentials, which may
include contacting the providers references,
licensing boards, and other relevant
entities. Updating the application Providers
must keep their CAQH ProView application
up-to-date by regularly updating their
information and submitting new documentation as
necessary.
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Guidance on CAQH Application Process

• The CAQH ProView application process is designed
  to simplify and expedite the credentialing and
  contracting process for healthcare providers. By
  using CAQH, providers can streamline the
  application process, reduce administrative
  burdens, and gain access to a wide range of
  healthcare networks and plans.
• List of Documents for CAQH Application
• To complete your CAQH ProView application, you
  will need to provide the following documents
• Personal Information Your name, address, phone
  number, email, and date of birth.
• Education Information about your education,
  including the name of the school(s), dates of
  attendance, and degree(s) earned.
• Work history A list of your previous work
  experience, including the name of the
  employer(s), job title(s), dates of employment,
  and a brief description of your duties.
• Licenses and certifications A list of all
  licenses and certifications you hold, including
  the issuing authority, the date of issuance, and
  the expiration date.
• Professional liability insurance Information
  about your professional liability insurance,
  including the name of the carrier, policy number,
  and expiration date.

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Guidance on CAQH Application Process

• Professional references The name, phone number,
  and email address of at least two professional
  references who can attest to your work experience
  and qualifications.
• Disclosure questions You will need to answer a
  series of disclosure questions about your
  background, including any criminal convictions or
  disciplinary actions taken against you.
• W-9 form This form is used to request your
  taxpayer identification number (TIN) for tax
  reporting purposes.
• Supporting documents You may be asked to provide
  additional supporting documents, such as your
  resume, a copy of your diploma or transcripts, or
  proof of your professional liability insurance
  coverage.
• Please note that the specific requirements may
  vary depending on the type of provider you are
  and the requirements of the insurance companies
  or health plans with which you are affiliated.
• List of Payers Required CAQH Account
• Many payers require healthcare providers to have
  a CAQH ProView account to simplify and streamline
  the credentialing process.
• Here are some payers that may require a CAQH
  ProView account

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Guidance on CAQH Application Process

• Aetna
• Anthem Blue Cross Blue Shield
• Cigna
• Humana
• UnitedHealthcare (UHC)
• Kaiser Permanente
• Medicare
• Medicaid
• Please note that this list is not exhaustive and
  may change over time. It is always best to check
  with each individual payer to determine their
  credentialing requirements.
• About Medical Billers and Coders (MBC)
• Medical Billers and Coders (MBC) is a leading
  revenue cycle management company providing
  complete medical billing and coding services.
  MBC's credentialing services are designed to help
  healthcare providers and organizations streamline
  their credentialing process, reduce
  administrative burdens, and ensure

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Guidance on CAQH Application Process
compliance with regulatory requirements. MBC's
credentialing team consists of experienced
professionals who can assist with provider
enrollment, primary source verification, and
other aspects of the credentialing
process. MBC's credentialing services can be
particularly helpful for healthcare organizations
that are struggling to manage the complex and
time-consuming task of credentialing, or for
providers who are new to the industry and need
guidance in navigating the credentialing process.
To know more about our provider credentialing and
enrollment services, email us at info_at_medicalbill
ersandcoders.com or call us at 888-357-3226.