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Updating Credentialing Information with Council for Affordable Quality Health (CAQH)

Date: 09/20/22

Reminder: Updating Credentialing Information with Council for Affordable Quality Health (CAQH)

CAQH, otherwise known as the Council for Affordable Quality Healthcare, is an online portal that stores provider information in a secure database.  Access to this secured information is granted to health insurance companies during the credentialing process to make acquiring up-to-date provider information more efficient. Instead of calling your office for your work history or a copy of your Medical License, they can go in and pull it directly from your file.  90% of the National Health Insurance Companies use CAQH and it is a prerequisite for the insurance enrollment process in most states.

The mission of CAQH is to improve health care access & quality for patients, and at the same time, reduce the paperwork and hassle for health care providers and their office staff.

What is CAQH Attestation?

Attesting your CAQH profile is the process of signing off on your CAQH application at the end of the application process.  In addition to initially attesting, you have to go back in and attest every 180 days which keeps your application active and provides your contracted insurance carriers with up-to-date credentialing information.  Failure to attest your CAQH application will result in your credentialing / recredentialing applications with the payers being delayed or rejected.  It’s critical that you keep up with CAQH and ensure your information is accurate.  Every time you receive a new malpractice policy, license, DEA certificate, W9 or address, it’s critical that you get this information updated in CAQH.

Practitioners should register and maintain their credentialing information on the Council for Affordable Quality Health (CAQH) website. Maintaining CAQH profile will prevent roster fall out that could adversely affect Par status with Ambetter of North Carolina Inc.

Summary of what is needed for practitioners for credentialing: 

  1. An attested CAQH profile within CAQH to ensure information stays current.
  2. Practitioners need to authorize Centene to access their CAQH profile, within CAQH itself. 
  3. Each practitioner should complete the state release form that is included in the documents sections of CAQH.

*NOTE* If practitioner is not in CAQH at all, Ambetter of NC Inc. will request a full practitioner application and additional required documents (insurance, License, etc). 

Primary care providers cannot accept member assignments until they are fully credentialed.

How can credentialing impact claims payments?

If provider data is not maintained in CAQH, it could indicate expired credentialing information back to Ambetter of North Carolina Inc., which leads to a provider becoming non-par and a claim denying based on par-status.

For more information, refer to your Participating Provider Agreement and the 2022 Provider and Billing Manual (PDF)