CAQH, Maintenance

CAQH Set Up and Maintenance

Devonn Simmons
May 5, 2021
11:00 am

CAQH is an online database that stores a provider’s historical information related to his medical education, licenses, malpractice history, practices that he currently works for, work history, and documents of all licenses, diplomas, board certifications, etc. The majority of payers require providers to have CAQH profiles as they use this information to credential and re-credential a provider. If the CAQH profile is not complete or not re-attested every 120 days, this could cause payer enrollment delays and cause the provider to lose their in-network participation status. If they sign up with maintenance with us, we monitor and update their CAQH, which never happens. If a provider does not already have a CAQH profile, we can set one up, and a lot of our clients opt for that service because it can take 2 hours or more to set up a profile, and providers typically do not have the time to spend working on it. CAQH ProView is the healthcare industry’s premier resource for providers to self-report professional and practices information to payers, hospitals, large provider groups, and health systems. CAQH ProView eliminates duplicative paperwork for these organizations that may require provider profile information for claims administration, credentialing, directory services, and more. Through an intuitive, profile-based design, you can quickly enter and maintain your information for submission to your selected organizations. CAQH ProView can be accessed at https://proview.caqh.org/pr. The following steps provide you with a high-level overview of the process to complete your data profile.

Register with the system.
Complete all application questions.
Review your data profile for accuracy.
Authorize participating organization’s access to your data profile.
Attest to your data profile.
Upload your supporting documentation.

This document will provide additional information and helpful tips for each of these steps. Getting Started Completing the initial CAQH ProView profile may take up to two hours; however, preparing yourself for the information requested will reduce the time required to complete your profile. Additional time may be necessary depending upon several factors, including the number of practice locations, amount of postgraduate training and work history, and overall familiarity with online tools and systems. While CAQH ProView was designed to be compatible with most Internet browsers, we recommend upgrading to the most current Internet Explorer version, Chrome or Safari, and using one of these browsers for the best performance. If your practice has an office manager or clinic administrator who assists with gathering information for credentialing or other administrative purposes for multiple providers, the CAQH ProView Practice Manager Module may facilitate your data entry process. Data that is the same for multiple providers (e.g., clinic name, address, and phone number) can be entered once by a practice manager, rather than having to be entered repeatedly for each provider. Please refer to Chapter 7: Importing Data from the Practice Manager Module for more information regarding this functionality. System Security The confidentiality and security of provider information and the privacy of system users are critical priorities for CAQH. CAQH has implemented information security policies, standards, guidelines, processes, procedures, and best practices to strengthen its security program and protect its information assets. CAQH ProView is designed to be compliant with laws and regulations relating to individually identifiable information privacy. The CAQH ProView solution is housed in secure data centers where multiple physical and electronic safeguards are implemented. Fast Internet access to application screens, passwords, and certificates is used to ensure only authorized use of the system. Powerful Transport Layer Security (TLS) encrypts the data in transition; the database content is also encrypted at rest and backup to prevent unauthorized access to CAQH ProView. Only authenticated users have access to their restricted data. Virus detection mechanisms are used to help ensure that the database and the websites are free of viruses. Routinely encrypted backups protect volatile system data and are secured in an off-site storage facility.