How to Complete Your CAQH Profile

A major step in getting on many insurance panels is completing a CAQH profile.

CAQH, short for Council for Affordable Quality Healthcare, allows insurance companies to use a single, uniform application for credentialing. Over 900 health plans, hospitals, and healthcare organizations use it and require practitioners to complete their CAQH profile before submitting their application.

This process may not be very straightforward, so we’re here to help. Follow these steps to complete your CAQH profile.

1. Get a CAQH Number

Before completing your CAQH profile, you may have started the credentialing process with an insurance company. Chances are, the company you want to get paneled with uses CAQH, but check the list of participating organizations on the CAQH website first to make sure.  If they do, you’ll receive a letter with your CAQH provider ID number. If you don’t receive it right away, call the insurance company two weeks later to make sure they received your initial paneling application and can give you your CAQH ID number.

Alternately, you can self-register with CAQH before starting the credentialing process with any insurance company. CAQH will send you a welcome email with your assigned CAQH number.

Once you get the number, don’t lose it: You’ll need it to complete your profile now and re-attest to the information later (more on that in step 3).

2. Have All Your Information and Materials Ready

While you’re not required to complete the CAQH in one sitting (that could take hours), it is better to have all the required information and materials ready ahead of time to speed up the process.

Here’s some information you’ll need to complete the CAQH:

• Basic personal information
• Education and training
• Specialties and board certification
• Practice location information, including the practice name and type, address, contact information, services, certifications, limitations, hours, partners, covering colleagues, billing, office manager, and credentialing contact
• Malpractice insurance information
• Work history and references
• Disclosure and malpractice history

And here are some materials you’ll need:

• CV or resume
• Malpractice insurance policy(ies)
• W-9(s)
• State license(s)
• Various ID numbers (UPIN, NPI, etc.)
• Drug Enforcement Administration (DEA) certificate (if applicable)
• Controlled and Dangerous Substances (CDS) certificate (if applicable)

Before starting the application, make sure your resume is perfect, with dates formatted as MM/YYYY and no gaps in employment. If there are gaps, you’ll be asked to fill them (even if it’s just a day), and if your resume dates aren’t formatted properly, your application may be rejected. Take the time to meet the requirements so you don’t have to do it again. Also be sure to have scanned copies of your required materials, as you will be asked to upload them as part of the application process.

3. Complete Your Profile

Once you have all of your information and materials ready, it’s time to complete your profile at CAQH.org.

We highly advise you do this online. The paper application is dozens of pages long, typically only prints correctly in color, and requires a data entry person to transfer all your information (if they even get around to doing it). It’s best to avoid that headache altogether.

If you can’t complete the CAQH in one sitting, make sure you save the information you’ve completed by clicking the “next” button at the bottom of the page. Once you’ve entered all the required information, the website will instruct you to review all of the information and attest that it’s all correct. Then you’ll receive a message that your file is complete.

Once you complete your profile, you will need to choose who has access to it. CAQH gives you two options: allow any insurance company that indicates they would like to have you on their panel to access your profile, or manually choose which insurance companies you want to be able to access your profile. The first option is great if you are looking to get on as many panels as possible, while the second is a better choice if there are one or more companies you would rather not work with.

While you only have to complete your profile once regardless how many insurance panels you’re applying for, you’ll be asked to “re-attest” to the information quarterly. So, don’t lose any of your application information, and respond to such requests quickly, since not doing so can lead to insurance companies refusing to pay claims. It only takes a few minutes to complete on average, anyway.

For tips on the rest of the process, check out our blog on getting on insurance panels. Good luck! 

Sources: GETTING STARTED, Council for Affordable Quality Healthcare; CAQH ProView List of Participating Organizations, Council for Affordable Quality Healthcare; Getting on Insurance Panels: Preparing for the Process, American Counseling Association; How To Register With CAQH, Tamara Suttle