CAQH and Medical Credentialing - CAQH TIPS

CAQH, the Council for Affordable Quality Healthcare, is often needed in conjunction with an insurance company’s application to complete one’s medical credentialing (i.e., to get on insurance panels). Major insurance companies like BCBS and Aetna use CAQH as a part of their application process.

There are a few important things you need to know about your CAQH application.

1) You need to be Invited.

You can’t just go on to CAQH and upload your information, you need to be invited by an insurance company. This creates a near “Chicken or the egg” situation where you need to first submit an application to an insurance company. Then, call that company about 2 weeks later to see if they received the application you sent and have generated you a CAQH number. Only then can you can go to CAQH, complete the application, which is –you guessed it–sent to the insurance company, who needs it to complete your application.

2) Never opt to fill out your CAQH on paper.

CAQH offers medical providers the option to complete the application online, or on paper. Don’t choose the paper option. First, the application is 50 pages long and only prints correctly in color. But second, and most importantly, when you submit a paper application to CAQH they need to hire some data entry person to transfer all your information. I’d like to say that they do a poor job–but the truth is…it just never gets done. I’ve submitted several application to CAQH in paper before realizing they lose more of them then they input. When you call to ask what happend to your paper application, they simply recommend you complete your CAQH application online.

3) Your resume better be perfect

One of the trickiest parts of getting a CAQH application completed that cuts the mustard is to make sure your resume is perfect. This means 2 things in specific. First, your dates of employment and education need to be in Month/Year format (that is 11/2010). If you don’t post dates, they reject your application and won’t send it on to the insurance companies. Second, make sure there are zero gaps in your employment history. Seriously, not a day–they’ll ask for something to fill the gap (hassle!).

4) Don’t forget your re-attestation

Four times a year you’ll receive an email from CAQH, asking for you to “Re-attest” to the information in your profile. Not doing this can cause major problems with your ability to accept insurance, as the lapse in CAQH will be known by the insurance companies you are panelled with. Re-attestation only takes a few minutes (if you can remember your provider number and password), so log in and get it taken care of ASAP.

If you’re looking for help getting on insurance panels, is available and can provide full-service medical credentialing. Call us toll-free at 1-(855) 664-5154.

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