CAQH—here we go, more red tape designed to make running a practice more complicated than it already is, or is it really? And why do you need it? Let’s explore the impact of CAQH participation on your practice.

What is CAQH?

You may already be well aware of what CAQH is, but for those who don’t, let’s quickly look at what it stands for and what its role is in the medical industry.

CAQH, the Council for Quality Healthcare, is a non-profit collaborative alliance of the nation’s leading health plans and networks. The objective is to have different stakeholders in healthcare working together to streamline administrative processes, with the overall goal of improving healthcare access and quality for patients. It sounds like a beautiful mission statement, but what does that really mean?

In short, CAQH is an online data repository of credentialing data. It serves as an online portal where medical providers report credentialing data such as basic personal information, education and training, work history, state license, malpractice history, DEA certification, and more. Although the list is exhaustive, it allows for more transparency and credibility in the healthcare industry. At the end of the day, it is primarily an online resume for healthcare providers, available for review by all insurances and other healthcare agencies.

Having all the information in one secure location streamlines the credentialing process. Instead of having to send all the information to different payers, there is one trusted location where all the data can be accessed quickly and efficiently. It is not mandatory to have a CAQH profile, but it is certainly recommended, especially if you want to become an in-network provider, as most insurance companies require CAQH registration.

Why is it Essential to Update and Attest Your Information on CAQH?

Only downside is that registering and reporting your information is not a one-off process. It requires continuous updating, and neglecting to do so may carry negative consequences.

Expect a prompt to update your information at least once every 120 days. In exceptional circumstances, this could be more often if specifically required. You will receive an automatic reminder to review and reattest your data. If there are no drastic changes since the last update, you can simply go online and reattest the information or do so by calling an automated telephone system.

Although this process is quite easy, it often happens that people neglect to attest. We’re all human, and life can be pretty demanding at times, leading us to forget to do certain things like going online quickly and attesting. Sometimes technical issues lead to no attestation. It often happens that the notification email from CAQH ends up in the spam folder and remains unseen and unactioned. Changes in administrative personnel or a switch in their duties and responsibilities could lead to a notification remaining unnoticed. There are many reasons this could happen, but the most important factor to consider is that it does happen, and quite often.

What Happens if You Don’t Update Your CAQH Information?

As mentioned before, you will receive a request about every four months to review, amend if need be, and reattest your information. You will also receive a notification of an attestation expiration date. If you don’t reattest before this date, you may face problems when external parties view your profile. It will read, “This profile is not attested,” and your information will not be visible to external parties. Failure to reattest in time could lead to payers delaying or even refusing credentialing or dropping the contract due to the reattestation problems on your profile. If you fail to reattest or fail to upload documentation requested by CAQH, your profile will be marked inactive after three to four email reminders.

How Do I Prevent CAQH Hiccups?

Creating and keeping your CAQH up to date is one of the many services we specialize in at Physicians Credentialing. Our proactive approach and monitoring processes will ensure that no hiccups arise that might have a detrimental effect on your cash flow. Click here to book a free, no-obligation consultation at a time that suits you so that we can assist you with all the CAQH queries you might have and more.

Thank you for reading, and remember to check back for more informative articles that could help you stress less and free your time to focus on providing excellent medical care to patients.