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.

An Independent Physicians Association (IPA) is an entity owned by a network of independent physicians with the purpose of reducing overhead and establishing contracts with Health Maintenance Organizations (HMO) and Managed Care Organizations (MCO). IPAs provide independent practices the freedom to deliver high-quality, personalized care to their patients while providing resources to stay competitive.

Credentialing, also known as provider enrollment, is often a mysterious subject for rehab therapy providers. Throughout your career as a provider, you’ve probably heard a bunch of credentialing myths that you may have taken as truth. Let’s explore some of the common misconceptions about credentialing and clarify them so this topic can be less daunting.

Credentialing has never been synonymous with fast. Many healthcare providers get frustrated with the long wait times (90-120 days) associated becoming an in-network group/provider. In this article, we’ll explain why the credentialing process takes so long even in the digital age, so you can better prepare for opening your practice or hiring additional providers.

1. PTA/OTA Reimbursement Cut Takes Effect in 2022

It’s been a year since CMS implemented CO/CQ modifiers for services provided “in whole or in part” to Medicare patients by PTAs and OTAs. In 2022, CMS will be reducing reimbursements by 15% for services with CO/CQ modifiers.

Many rehab therapists believe that once they are in-network with an insurance panel, they are an in-network with the insurance indefinitely. This is just one of the common misconceptions of credentialing. The truth is, group and individual providers need to complete recredentialing applications periodically to remain in-network. Let’s take a closer look at recredentialing to avoid unexpected contract termination.

When a healthcare provider gets married and takes their spouses last name, they will update their driver's license, bank accounts, car insurance, etc. With so many crucial areas that need updating, providers might forget to notify the insurance carriers in which their employer participates. Providers must update their professional license and national provider identifier (NPI) with this change, as well as the individual insurance companies.  

Therapists put in years to fulfill the educational courses to become a therapist.  It is an awesome field to be in.  Just one thing about the education, the curriculum does not typically include classes on important administrative issues that are vital to a therapists starting their professional career.  Once they take and pass the exam to become a licensed therapist the search for employment begins. 

What is a closed panel?

Many healthcare providers are unfamiliar with the credentialing process because they worked in a setting in which it wasn’t required, or their employer handled their enrollment. So, it only makes sense that providers can be intimidated by the amount of work that goes into credentialing when they attempt it for their own practice. We have outlined four ways to streamline credentialing so you can start treating patients as soon as possible.