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CAQH Provider Data – Help Page

Provider Help:

Question Answer
1. What does CAQH offer the healthcare industry? CAQH provides technology-driven solutions to reduce costs, streamline administration, and make healthcare work better for payers, providers, and members.
For more information, please visit www.CAQH.org.
2. What is the CAQH Provider Data Portal? The CAQH Provider Data Portal collects, verifies, and manages the industry’s most extensive, up-to-date, and trusted source of healthcare data to enable plans, providers and other organizations to streamline operations, reduce costs and transform business processes. CAQH Provider Data Portal automates provider data collection by using a standardized electronic application that meets the needs of nearly every health plan, hospital, and other healthcare organization.

The CAQH Provider Data Portal enables physicians and other healthcare professionals in all 50 states and the District of Columbia to enter information free-of-charge into a secure, centralized database. Authorized healthcare organizations can access that information to assist with specific business processes.
3. What business challenges does the CAQH Provider Data Portal help solve? By streamlining data collection, the CAQH Provider Data Portal reduces redundant paperwork and saves millions of dollars in annual administrative costs. This benefits the 2.5 million healthcare providers and 1,000 health plans, hospitals and other healthcare organizations that use the CAQH Provider Data Portal.
4. What administrative processes does the CAQH Provider Data Portal help simplify? The CAQH Provider Data Portal is the trusted source and industry standard for collecting provider data used in credentialing. This data can also be used for network directories, coordination of benefits, quality assurance, emergency response, member services and more.
5. What is credentialing? Healthcare organizations such as health plans and hospitals evaluate physicians and other health care providers with whom they contract to confirm that these providers are adequately trained, certified and/or licensed to provide care. One of the most important parts of the credentialing process is the collection and verification of vital data regarding the healthcare provider's education, training, experience, practice history, location, disclosure of any issues impacting their ability to provide care, and other background information.
Three steps are involved in completing the credentialing process:
  • CAQH collects self-reported data from providers (education, training, location, etc.). This is the information that the CAQH Provider Data Portal collects and shares with organizations the provider chooses.
  • Participating Organizations verify certain provider-reported data against third-party sources, also called Primary Source Verification.
  • Participating Organizations review the data in order to make an independent decision about whether the provider in question meets the standards of an organization required to provide care.
6. Why is simplifying credentialing an important issue? 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 simplifies the process by enabling providers to submit one standard credentialing application to a single source, the CAQH Provider Data Portal, to satisfy the credentialing requirements of all participating health plans. This significantly reduces the administrative time and effort to submit a credentialing application.
7. Where can I get additional information about this solution? Please visit https://proview.caqh.org/pr for more information on the CAQH Provider Data Portal.
8. Who is able to access the CAQH Provider Data Portal? Every health plan may use the CAQH Provider Data Portal 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. Does it cost anything to use the CAQH Provider Data Portal? There is no cost for physicians and other health care providers to use the CAQH Provider Data Portal.
10. How can I access the CAQH Provider Data Portal? You can register online at https://proview.caqh.org/pr or you will receive registration instructions once a healthcare organization notifies CAQH that you need to access the database. Once registered, you can use your CAQH Provider ID and password to access the CAQH Provider Data Portal.
11. How often must I update my information? You will be sent automatic reminders to review and attest to the accuracy of your data. You must review and authorize data once every four months. You can attest and make changes to your record anytime by accessing your information online.
12. Do I need to complete the entire profile? Yes. You must complete all profile questions. The CAQH Provider profile will present questions that are relevant to your particular specialty, provider type and practice location(s). The system is designed to allow you to complete your profile over time. You can stop any time, save what you have completed, and return later to finish the process. The entire profile must be completed prior to your verification of its accuracy, and before the participating health plans that you have authorized can access it.
13. Can I use the CAQH Provider Data Portal to report any changes to my practice such as address and phone number? Your agreement with each of the health plans and healthcare organizations typically requires you to communicate certain changes to your personal information immediately. Rather than contact each of these organizations individually, you can enter your changes once into the CAQH Provider Data Portal. Only organizations that participate in CAQH Provider Data and that have been authorized by you to access your information will receive any changes. You will still need to contact any non-participating organizations directly.
14. Can any organization access my data? No. You control which organizations have access to your information. When completing your profile, you will indicate which healthcare organizations and health plans are authorized to access your data.
15.What if I am affiliated with an organization that is not participating in the CAQH Provider Data Portal? If you are affiliated with an organization that is not participating in the CAQH Provider Data Portal, you will need to continue to work with that organization directly. Healthcare organizations and health plans are invited to participate in the CAQH Provider Data Portal, regardless of whether they are members of CAQH. If one of the health plans with which you work is not currently using the solution, please ask them to visit the CAQH website at www.CAQH.org or call 202-861-1492.
16. How do I contact the CAQH Solutions Center? Please contact the CAQH Solutions Center via live chat or by calling 1-888-599-1771. Live chat can be accessed by logging in to your account and clicking the chat icon at the bottom right hand side of the pages.
  • Chat hours are:
  • Monday – Friday: 8:30 AM to 6:30PM (EST)
  • Phone hours are:
  • Monday – Friday: 8 AM – 8 PM (EST)
17. How does the CAQH Provider Data Portal ensure the confidentiality and security of my organization’s provider data? The confidentiality and security of provider data and the privacy of system users are critical priorities for CAQH. In addition, the CAQH Provider Data Portal is HITrust CSF Certified, meeting regulations for protecting and securing private healthcare information.

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 access 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 system data and are secured in an off-site storage facility.