Your CAQH Profile Is Probably the Slowest Part of Credentialing

If you ask a room of practice managers which part of credentialing they dread, a lot of them will say the same thing: CAQH. Not because it is hard, exactly, but because it is the kind of task that gets pushed down the list until a payer emails to say they cannot move forward.

It is worth understanding why this one profile matters so much. Many payers use CAQH ProView as their main source of information about a provider. They do not retype your details. They pull what is in the profile. So if the profile is out of date, the payer is working from out-of-date information, and your application waits.

The usual ways a profile goes wrong

The most common problem is simply age. Someone set it up when the provider first started, and then a license renewed, the malpractice policy changed and the practice moved offices, and nobody went back in. The documents uploaded months ago have expired, even though everything is current in real life.

The second is a mismatch. The practice address on the profile is one version, the address on the enrollment form is another, and the tax ID is formatted differently in a third place. A reviewer cannot tell which is right, so they stop and ask. That one question can cost days or weeks, depending on how fast it travels back and forth.

The third is permission. A profile can be complete and perfect and still do nothing for you if the payer has not been authorized to view it. It is an easy step to forget, and it looks from the outside exactly like a slow payer.

Re-attestation is not optional busywork

CAQH asks providers to confirm on a regular schedule that the information is still correct. It is usually described as every 120 days, and CAQH sends reminders. The reminders go to whatever email address is on the profile, which is why we would say this one thing above all others: make sure that email address is current and that somebody actually reads it. A missed reminder can leave the profile marked as out of date at exactly the wrong moment.

A five-minute check

Before you start any new application, open the profile and read it the way a reviewer would. Are all the sections complete? Do the dates in the work history run without unexplained gaps? Are the license, DEA registration if it applies, and malpractice certificate all current? Does the practice address match what you are about to put on the application? Are the payers you are applying to authorized?

If you want something to tick through, we made a one-page CAQH profile readiness checklist you can download and print. There are more on our Resources page.

And if keeping up with all of this is more than you have time for, that is a big part of what we do. Take a look at our services, or send us a note and tell us where things are stuck.

This article is general information, not legal or financial advice. Requirements vary by state and payer.

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