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CAQH: Definition, Explanation, Importance

CAQH: Definition, Explanation, Importance

Council For Affordable Quality Healthcare Defined And Explained

CAQH: The Council Defined

CAQH, or the Council for Affordable Quality Healthcare, is a non-profit organization of national healthcare networks and plan providers whose objective is to improve the quality of healthcare and its accessibility. It’s primarily designed for providers and their staff in order to eliminate confusion, reduce paperwork, and streamline information gathering and dissemination.

Many healthcare providers or physicians must have a contract with multiple organizations in order to provide adequate healthcare to their patients. This is time-consuming and expensive. The Council aims to eliminate the need for multiple contracts through the consolidation of services. Healthcare providers and organizations will contract with the Council and complete a single application with a single source, which is the Council. Information can be updated with one source rather than multiple organizations, which saves time and money for the provider.

The Council Explained

The council is a service provided to healthcare organizations such as hospitals, insurance companies, and doctors’ offices to simplify provider access. Members don’t have to contract with multiple organizations in order to meet their patient obligations; rather they obtain it from the Council. The Council is the repository for the information collected from the providers so that when members need contract work, it’s easily obtained.

Removing the necessity of multiple contracts enables healthcare providers to spend more of their time on providing healthcare to their patients rather than tending to administrative duties. It also ensures that contract companies will be of high quality and fully vetted before interfacing with patients or conducting transactions within the medical or dental setting.

Security Of Information

Each provider submits a single application to the Council and it’s stored in a confidential database that’s routed through multiple firewalls in order to ensure privacy and eliminate hacking. Security is further ensured by 128-bit Secure Socket Layer encryption and only users with password and PIN authentication can access the data.

Only healthcare organizations who are authorized by the patient can access the patient’s records, and providers have access to their records but not those of other organizations. The Council is moving toward full automation of the authorization process so that pre-approvals will be more accurate and more consistent without human interface, but the fully automated objective is still in process.

Who Should Use The CAQH System?

Medical doctors, osteopathic doctors, podiatrists, nurse practitioners, dentists, licensed psychologists, some physical therapists, some oral surgeons, and others can use the Council. For more information, check web-DENIS or visit the Council’s website at Members have found that using the Council eliminates considerable paperwork in their offices, and it decreases the likelihood of user error since the data is entered once when it’s input into the provider enrollment database. Although previously used primarily by those in the medical field, dentists are finding it to be very advantageous, and it’s expected to be the leading source in the industry for data on dentists’ credentialing.

Another attractive feature of this system is their webinars. Members, including participating organizations, can easily train their employees in the use of the system through scheduled webinars on their website. A variety of dates and times are available so that members can train their employees at their convenience.

Locating participating healthcare providers is as close as the internet using the List of Participating Organizations on the website. Health plans, PPO networks, dental organizations, hospitals, and many more are located on this page and can be an invaluable resource, providing accurate information in an instant.

Use Of Information

Information on those who enroll in the program will be entered by the organization responsible for updating corporate provider information, which is the Provider Enrollment and Data Management organization. No one else will have access to an entity’s information except those that are specifically authorized by the entity. Information that is available to the Provider Enrollment and Data Management organization includes the physical, billing, and payment addresses, the specialty, and the tax identification number. These items are essential elements of providing contracts, so they must be kept current.

Updated Information

In order to maintain the most accurate database possible, the Council recommends that members update their information at least quarterly or every four months at most. Members are sent electronic reminders to verify the accuracy of their data, but changes should be reported immediately, either online or with a phone call. CAQH has a new system. Artificial intelligence, or AI, has been developed that will improve the accuracy of their data without the need for provider interface. This revolutionary, patent-pending process will ensure that their database is as current as possible and eliminate the need for human updates that cost time and money.

Cost Of The Program

Healthcare organizations and plan providers pay a fee to access the information in the provider enrollment database but users aren’t assessed a fee for obtaining information. Medical and dental providers have found that using the Council can save millions of dollars annually because they don’t need to duplicate the efforts that the Council has made; accurate information is already in the provider enrollment database.

Quality Control

The Council’s database also maintains credentialing solutions that enable others to verify the status of a provider. Any sanctions or infractions against a provider will be included, so members can provide their patients with the best care possible.

Advantages Of Using CAQH

Consolidation of information can save millions of dollars each year while maintaining the most current and accurate information available on its members. The Council provides the most reliable list of benefits for individuals and its credentialing process ensures that patients receive care from competent providers. Especially for new medical or dental practices, the Council can make a significant difference in their bottom line.


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