What Is CAQH?
CAQH provides a centralized provider data platform used by healthcare providers and participating health plans for credentialing-related information.
The CAQH Provider Data Portal allows providers to enter, maintain and share professional information with participating plans.
For many mental health providers, maintaining an accurate CAQH profile is an important part of the credentialing process.
Why Is CAQH Important?
Without a centralized provider profile, providers may have to repeatedly provide similar information to different health plans.
CAQH is designed to reduce that duplication for participating plans.
But an important distinction is:
A CAQH profile is not the same thing as being credentialed with an insurance company.
A payer may still require its own application, contracting process, documentation or approval.
What Information Goes Into CAQH?
The exact information required can vary, but providers may need information relating to:
Personal Information
- Legal name
- Contact information
- Address
- Date of birth
- Other identifying information
Professional Information
- NPI
- Taxonomy
- Licenses
- Certifications
- Education
- Training
- Work history
Practice Information
- Practice locations
- Group affiliation
- Hospital affiliations where applicable
- Professional relationships
Insurance Information
- Malpractice coverage
- Policy information
- Expiration dates
Other Information
Depending on the provider and payer requirements, additional information may be requested.
Step 1: Create or Access Your CAQH Profile
The provider establishes or accesses the appropriate CAQH profile.
The provider should use accurate legal and professional information.
Step 2: Complete the Profile
Enter the requested information carefully.
Small inconsistencies can create problems when information is compared with other credentialing records.
For example:
- Name differences
- Address differences
- License information
- Employment dates
- NPI information
should be reviewed carefully.
Step 3: Upload Required Documents
Depending on the profile and applicable requirements, supporting documentation may be required.
Keep copies of submitted documents organized.
Step 4: Authorize Participating Plans
The provider may need to authorize participating health plans to access the applicable CAQH information.
This is an important step because a complete profile isn't necessarily useful to a payer if the payer cannot access the information it needs.
Step 5: Attest
Providers should review the information and complete the applicable attestation process.
CAQH's credentialing materials describe provider data maintenance and attestation as part of its platform.
Step 6: Keep CAQH Updated
Credentialing isn't finished forever.
Providers should update information when circumstances change and complete required re-attestation.
Important changes can include:
- New license
- New practice address
- New group
- New employment
- New malpractice policy
- Updated contact information
- Other professional changes
Common CAQH Problems
Incomplete Profile
Missing information can delay credentialing.
Expired Documents
Expired licenses or malpractice information can create problems.
Incorrect Practice Location
The payer may need the exact location where services are being provided.
Employment Gaps
Work history may need to be complete and accurately documented.
NPI Mismatch
NPI information should be consistent across applicable credentialing records.
Failure to Re-Attest
An outdated profile may cause delays when a payer accesses it.
CAQH Does Not Equal Credentialing
This is one of the most important things for providers to understand.
Think of CAQH as part of the credentialing infrastructure.
It does not automatically make you:
- In-network with every payer
- Enrolled with Medicare
- Enrolled with Medicaid
- Contracted with commercial plans
Each payer's requirements still need to be addressed.
Need Help With Mental Health Credentialing?
Mental Health Medical Billers provides credentialing and insurance enrollment support for mental and behavioral health providers.
We can help with applicable credentialing workflows, CAQH-related tasks, payer applications, enrollment follow-up and status tracking.
[Request Credentialing Support →]