Credentialing is a crucial step for health and wellness clinicians looking to join insurance networks and grow their practice. The Council for Affordable Quality Healthcare, commonly known as CAQH, simplifies this process with its centralized application platform. Successfully navigating the CAQH application process is essential  for private practices to streamline insurance billing and improve patient access to care. In this article, we’ll share practical tips to help small and medium-sized private practices navigate the CAQH application efficiently and set up their insurance billing workflows for success.

What is a CAQH application?

The CAQH application is a standardized tool designed to simplify the credentialing and re-credentialing process for clinicians. By using this platform, clinicians can securely submit their license and practice information to insurance plans and healthcare organizations. This not only reduces administrative burdens but also ensures a smoother, more efficient path to joining insurance networks. 

How long does it take to get credentialed with CAQH?

The CAQH credentialing process can take anywhere from a few days to several weeks, depending on how quickly your profile is completed and verified. Setup of your CAQH profile might take several hours as it involves gathering and entering detailed information about your practice, clinicians, and professional credentials. Once submitted, insurance providers will review and verify your profile. The timeline largely depends on the completeness and accuracy of the information you provide. To avoid lengthy delays, double-check that all details are correct and up-to-date before submitting your application. 

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How much does CAQH credentialing cost?

The CAQH application, profile, and Provider Data Portal (used to store and maintain your information) are completely free for healthcare clinicians and practices. While clinicians do not incur any fees, health plans and other healthcare organizations pay to access CAQH’s Provider Data for credentialing purposes. 

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 your work. To ensure a smooth review, confirm that your references are willing and available to vouch for 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 certifications.
• Education details: Degrees, certifications, and training history.
• Work history: Comprehensive work experience and employment records.
• Malpractice insurance: Details of your coverage, if applicable.
• DEA certificate: Information regarding your Drug Enforcement Administration (DEA) registration, if required.
• Personal information: Social Security number, addresses, and contact details.
• Practice information: Details about your services, clinicians, and hospital affiliations. 

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 streamline administrative tasks and improve practice efficiency. The right EHR can simplify data entry, reduce errors, and improve billing accuracy by automating claim submissions, tracking payments, and managing patient insurance details. 

When choosing an EHR, consider its compatibility with CAQH to facilitate seamless information exchange. For example, an EHR like Healthie supports the CAQH application process and  keeps clinician data accurate and up-to-date for credentialing and billing. This integration ensures your billing workflows are efficient, helping you save time and avoid administrative headaches. 

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 EHR for small and medium-sized private practices. With a wide range of features and customizable tools, Healthie makes it easy for you to stay organized and focus on providing fantastic care to your clients. 

For practices navigating the CAQH credentialing process, Healthie offers integration to support your insurance billing workflows. Features like automated claim submissions, client insurance management, and secure data storage ensure your credentialing and billing processes are error-free. By choosing Healthie, you’ll have a comprehensive solution to manage your practice while keeping everything organized in one place.