What is a CAQH Proview Profile?

The Council for Affordable Quality Healthcare (CAQH) launched the CAQH ProView Profile in 2002 with the purpose of eliminating redundant paper applications during provider enrollment. Healthcare providers can register for an account at no cost and input their demographic, professional, and practice information for health plans to access during the insurance enrollment process.

This was supposed to be a huge technological step for the healthcare industry, but 20 years later, it hasn’t quite changed the game as much as we (people who work in credentialing) would have hoped. We’ll explain why later in this article.

Who Needs a CAQH ProView Profile?

All healthcare providers working in an outpatient private practice setting who intend to bill insurance as an in-network provider need a CAQH ProView Profile. Most health insurance companies require a CAQH ProView ID number to be listed on initial credentialing applications. If you hire physical, occupational, or speech therapists, make sure their CAQH ProView is set up and attested or plan to get them registered. Providers can visit the CAQH ProView website to register and will need to fill out the required information.

Providers should allocate 1-2 hours to complete their CAQH ProView Profile and will need supporting documents such as license and professional liability insurance policy. The system is great at letting providers know what required information is missing. Once all sections are complete, providers should attest their profile. CAQH requires providers to re-attest their information is accurate every 120 days.

How Does CAQH Affect Credentialing?

As we stated earlier, most insurance companies will ask for the enrolling provider’s CAQH ID number on their credentialing application. Payors will access a provider's CAQH to verify demographic and professional information prior to approval. If your CAQH ProView Profile is incomplete, unattested, or access is not permitted, the credentialing application will get rejected until the issue is resolved. Updating and attesting your profile every 120 days is the easiest way to avoid credentialing delays. Insurance companies will utilize these profiles during the recredentialing process as well.

The convenience that CAQH ProView Profiles promise leave something to be desired. This is because, despite their purpose of eliminating tedious credentialing applications, many insurance companies require healthcare providers to submit lengthy credentialing applications. Even though most of the information can be found in the provider's CAQH ProView Profile.

Bottom line, this is an extremely useful tool for providers and health insurance companies to exchange provider data in a secure way, but hasn’t made credentialing as convenient as credentialing managers and practice owners would have hoped.

If you or your administrative staff need assistance with these tedious credentialing applications or getting your providers established with a CAQH ProView Profile, give us a call at 508-422-0233 or send us an email at info@accountmattersma.com to learn how our experts can help.