CAQH

The Council for Affordable Quality Health Care, an organization that maintains a universal provider database (CAQH ProView) used by most health plans to collect and verify credentialing information from providers.

CAQH stands for the Council for Affordable Quality Healthcare, but in practice, when someone says "CAQH" they almost always mean CAQH ProView, the online credentialing database that most commercial payers use. Here is how it works: you create a profile on ProView and enter all your professional information once. Education, training, licenses, certifications, malpractice history, practice locations, hospital affiliations, and work history. Then you authorize individual payers to access your profile. When those payers need to credential or re-credential you, they pull your data from CAQH instead of asking you to fill out yet another paper application. The system saves an enormous amount of time. Without CAQH, enrolling with 15 payers means filling out 15 separate applications, each asking for the same information in slightly different formats. With CAQH, you fill it out once and maintain it in one place. But here is the catch that trips up a lot of providers: CAQH requires re-attestation every 120 days. That means every four months, you need to log in, review your information, confirm nothing has changed (or update what has), and click the attestation button. If you do not re-attest within the 120-day window, your profile goes inactive. Payers cannot access it, and your credentialing or re-credentialing applications stall. Not every payer uses CAQH. Some regional Blue Cross Blue Shield plans have their own portals. Some Medicaid managed care organizations have separate enrollment processes. Medicare does not use CAQH at all; they use PECOS. But the majority of commercial payers in the United States rely on CAQH ProView, so keeping your profile current is one of the most important administrative tasks for any practicing provider. One more thing: CAQH ProView is free for providers. There is no cost to create or maintain your profile. The payers pay CAQH for access to the data.