CAQH ProView – Help Page
Transition from Universal Provider Datasource to CAQH ProView:
Participating Organization Help:
- What is CAQH?
- What is CAQH ProView?
- How is CAQH ProView different from the current Universal Provider Datasource?
- What business challenge does CAQH ProView help solve?
- What administrative processes does CAQH ProView help simplify?
- Why is administrative simplification for credentialing an important issue?
- Where can I get additional information about this solution?
- Who is able to access CAQH ProView?
- Which departments within a participating organization are affected by CAQH ProView?
- Does the CAQH application take into account the accreditation requirements set by groups such as NCQA, JCAHO and URAC?
- Is CAQH ProView applicable in states where there is a state-mandated application?
- Is Primary Source Verification included as part of CAQH ProView?
- If my organization uses a credentials verification organization (CVO) for primary source verification, will the CVO be allowed to access the database on behalf of my health plan?
- Is my organization be able to request additional information outside of the information gathered on the profile?
- Is my organization required to utilize CAQH ProView?
- My health plan is not a CAQH member. Is CAQH membership required to use CAQH ProView?
- How much does it cost to access CAQH ProView?
- I want to use CAQH ProView. How do I get started?
- Who do I contact for administrative support questions when utilizing the system?
- How does CAQH ProView ensure the confidentiality and security of provider information?
|1. What is CAQH?||CAQH, a non-profit alliance, is the leader in creating shared initiatives to streamline the business of healthcare. Through collaboration and innovation, CAQH accelerates the transformation of business processes, delivering value to providers, patients and health plans. For more information, please visit www.CAQH.org.|
|2. What is CAQH ProView?||CAQH ProView – previously known as CAQH Universal Provider Datasource – is an online provider data-collection solution. It streamlines provider data collection by using a standard electronic form that meets the needs of nearly every health plan, hospital and other healthcare organization.
CAQH ProView enables physicians and other healthcare professionals in all 50 states and the District of Columbia to enter information free-of-charge into a secure central database and authorize healthcare organizations to access that information. CAQH ProView eliminates redundant paperwork and reduces administrative burden.
|3. How is CAQH ProView different from the current Universal Provider Datasource?||All of the benefits of the CAQH Universal Provider Datasource (UPD) are also part of CAQH ProView. This includes the current electronic data collection and credentialing capabilities that streamlines healthcare administration and reduces costs.
CAQH ProView has significant improvements over UPD. CAQH ProView’s time saving features include:
|4. What business challenge does CAQH ProView help solve?||By streamlining data collection electronically, CAQH ProView reduces duplicative paperwork and saves millions of dollars of annual administrative costs. This benefits both the 1.2 million healthcare providers and more than 700 participating health plans, hospitals and other healthcare organizations that use CAQH ProView.|
|5. What administrative processes does CAQH ProView help simplify?||CAQH ProView is the trusted source and industry standard for collecting provider data used in credentialing. In the future, this data can also be used for claims processing, quality assurance, emergency response, member services and more.|
|6. Why is administrative simplification for credentialing an important issue?||Administrative simplification of the credentialing process helps providers increase their compliance with an organization’s requirements. The paperwork associated with credentialing is a time-consuming task facing physicians, other health care providers, practice managers and healthcare organizations. A typical healthcare provider contracts with 10 - 20 healthcare organizations, each requiring the provider to complete an extensive credentialing application.
CAQH ProView simplifies the process by enabling providers to submit one standard credentialing application to a single source, the CAQH ProView credentialing application database, to satisfy the credentialing requirements of participating health plans. This significantly reduces the administrative requirements associated with the credentialing application process.
|7. Where can I get additional information about this solution?||Please visit https://proview.caqh.org/po for more information on CAQH ProView.|
|8. Who is able to access CAQH ProView?||Every health plan may use CAQH ProView if they choose to participate. Other healthcare organizations that handle credentialing functions on behalf of health plans – or that have their own need for credentialing –may also choose to use the solution. In all cases, providers must submit authorization for a health plan to access their information.|
|9. Which departments within a participating organization are affected by CAQH ProView?||As CAQH ProView continues to add new functionality, credentialing, quality assurance, claims, member services departments and others will be able to benefit from the rich provider data in CAQH ProView.|
|10. Does the CAQH provider profile take into account the accreditation requirements set by groups such as NCQA, JCAHO and URAC?||Yes. CAQH designed this solution with input from NCQA, JCAHO, URAC as well as many health plans and a work group of healthcare providers. CAQH developed CAQH ProView through a collaborative effort to help improve the credentialing process for all stakeholders.|
|11. Is CAQH ProView applicable in states where there is a state-mandated credentialing application?||Yes. In states where legislation mandates the use of a standard credentialing application form, the data collected through CAQH ProView will include the data elements and/or form required by the state. The solution directs the provider to complete the necessary questions to fulfill the requirements for the state in which the provider's primary office address is located.|
|12. Is Primary Source Verification included as part of CAQH ProView?||No, Primary Source Verification is not currently part of CAQH ProView. This solution currently addresses only the data collection part of the credentialing process. Health plans and other related organizations independently perform primary source verification on certain data that is collected, as well as make their own decisions about whether a provider meets that organization's standards for participation.|
|13. If my organization uses a credentials verification organization (CVO) for primary source verification, will the CVO be allowed to access the database on behalf of my health plan?||Yes. A Participating Organization Administrative user can grant a CVO access to the profile of the Participating Organization.|
|14. Is my organization be able to request additional information outside of the information gathered on the profile?||CAQH ProView simplifies the administrative process with a streamlined robust data set that is extensive and complete. Participating health plans should not routinely need to seek additional information beyond what is in the CAQH ProView profile. Health plans may need to clarify or confirm certain responses in the application with individual physicians and other health care providers on a case-by-case basis.|
|15. Is my organization required to utilize CAQH ProView?||CAQH ProView is completely voluntary. All health plans and healthcare organizations may use and benefit from using CAQH ProView but are not required to do so.|
|16. My health plan is not a CAQH member. Is CAQH membership required to use CAQH ProView?||No, any health plan may use CAQH ProView if it registers to become a participating organization. Health plans also interested in CAQH membership may visit www.CAQH.org to learn more.|
|17. How much does it cost to access CAQH ProView?||Health plans and other healthcare organizations using CAQH ProView pay administrative fees and an annual fee per provider to access the database. For more information contact CAQH at 1-202-861-1492 or email email@example.com.|
|18. I want to use CAQH ProView. How do I get started?||Health plans and other healthcare organizations interested in using CAQH ProView may contact CAQH at 1-202-861-1492, or email firstname.lastname@example.org.|
|19. Who do I contact for administrative support questions when utilizing the system?||Contact the CAQH Help Desk via email at email@example.com.|
|20. How does CAQH ProView ensure the confidentiality and security of provider information?||The confidentiality and security of provider information and the privacy of system users are critical priorities for CAQH. CAQH ProView is designed to be compliant with federal and states laws, rules and regulations relating to the privacy of individually identifiable health information. In addition, CAQH will comply with applicable laws and regulations pertaining to confidentiality and security in the development of the database and the data collection process.
The CAQH database is housed in a secure Tier 3 Datacenter. Access to the cage is limited to authorized Support staff and controlled by multiple levels of physical security. All network traffic to and from the center is routed through redundant firewalls for complete security to the database and online systems. Secure Internet accesses to application screens, use of passwords, electronic signatures/certificates, and powerful Secure Socket Layer (SSL) encryption are used to ensure only authenticated use of the system. Only password/PIN-authenticated users have access to their restricted data over connections that automatically encode all information exchanges. Virus detection mechanisms are used to ensure that the database and the Websites are free of all viruses. Routine encrypted back-ups protect all volatile system data and are secured in an off-site storage facility.