Tips for Filling Out Your CAQH Application

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In the health and wellness industry, credentialing plays a pivotal role as it ensures that your practice meets the standards required to participate in insurance networks. The Council for Affordable Quality Healthcare, commonly known as CAQH, offers a streamlined process for providers to complete their credentialing. Successfully navigating the CAQH application process is crucial for private practices, especially in the context of insurance billing. Here are some tips to assist small and medium-sized private practices in navigating the CAQH application process efficiently and building their insurance billing workflows. Read on to explore our simple CAQH application instructions.

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What is a CAQH Application?

CAQH is designed to streamline the provider credentialing and recredentialing process. Healthcare providers use the CAQH application to submit their professional and practice information to insurance plans and healthcare organizations, simplifying the credentialing process and reducing administrative burdens.

How Long Does It Take To Get Credentialed with CAQH?

Completing the credentialing process with CAQH can vary in duration, with the overall process taking anywhere from a few days to several weeks. There is the initial setup of a CAQH profile, which might take several hours as it involves gathering and inputting detailed information about your practice and providers. Once complete, the profile will go through the verification and review process by the insurance providers. The timeline largely depends on the completeness and accuracy of the information provided in the profile. To avoid lengthy delays, it is essential to fill out the application meticulously, ensuring all information is accurate and up-to-date. 

How Much Does CAQH Credentialing Cost?

The CAQH application, profile, and Proview database (used for storage and maintenance)  are free for healthcare providers and practices. Health plans and other healthcare organizations pay fees to use the CAQH Provider Data for credentialing. 

What Are Professional References in CAQH?

Professional references in the CAQH application serve as an authentication of your professional standing. These references validate your work experience and professional relationships, confirming your qualifications, skills, and ethical standards. Typically, you will be asked to provide a set number of professional references, often including supervisors, colleagues, or professionals familiar with their work. It is helpful to ensure the individuals listed as references in your CAQH application are willing and available to verify your professional background if contacted.

How do I Fill Out a CAQH Application?

The CAQH application requires several documents and details for a successful submission. These may include but are not limited to:

• Professional license information: Copies of your professional licenses and/or certifications.
• Education details: Information about your education, including degrees, certifications, and training.
• Work history: A detailed history of your work experience and employment information.
• Malpractice insurance: Details of your malpractice insurance, if applicable.
• DEA Certificate: Information regarding Drug Enforcement Administration (DEA) registration, where necessary.
• Personal information: Details such as Social Security numbers, addresses, and contact information.
• Practice information: Information such as services provided, physicians employed, and hospital affiliation information. 

Ensuring that these documents are readily available and up to date will facilitate a smooth and efficient application process.

Insurance Billing & EHR

Integrating your Electronic Health Record (EHR) system with your insurance billing process can significantly streamline administrative tasks and enhance overall efficiency within your practice. Selecting an EHR system that seamlessly integrates with your billing processes can simplify data entry, reduce errors, and improve billing accuracy. The EHR software can help automate claim submissions, track payments, and manage patient insurance information, ensuring a more efficient billing workflow.

When choosing an EHR system, consider its compatibility with CAQH to facilitate the exchange of information. An EHR, such as Healthie, that supports the CAQH application process and seamlessly incorporates provider data can simplify the maintenance of accurate and updated information for credentialing and billing purposes.

How Healthie can benefit your practice

Healthie is an all-in-one practice management platform, designed with private practices in mind, making it the best EMR for small practices. We offer a wide range of features and customizations that make it easy for you to stay organized and focus on providing fantastic care to your clients. Try Healthie risk-free today by signing up for our free Starter Plan.