CAQH: Frequently Asked Questions

You know that CAQH is important for credentialing and payer enrollment for your practice. But what exactly is CAQH and how does this organization contribute to reducing healthcare costs – especially administrative costs – while increasing information accuracy?

Here are some FAQs about CAQH that you may find helpful and informative:

What is CAQH and how did it start? The Council for Affordable Quality Healthcare, Inc. was incorporated in 1998 and is a not-for-profit alliance of leading health networks and plans. Its mission is to improve patient healthcare quality and access and reduce the administrative burden for providers.

What is the CAQH credentialing database? The CAQH database is a single source of data on physicians and other health care providers. Then when a health plan or network needs information on a physician’s credentials, they can access the database.

How often is the information in the CAQH credentialing database validated? Every quarter, the system requests updates or validation of the database information. Only those organizations that the providers have authorized will be able to receive CAQH information.

Does the system notify health plans of any provider information changes or updates? Yes, the system automatically notifies these plans of updated provider information.

What is the advantage of streamlining the credentialing and payer enrollment process through the CAQH system? Instead of a physician or healthcare provider completing multiple applications for various healthcare organizations, only one standard application is needed for the CAQH database.

Does Medicare use the CAQH database? CAQH is used primarily by commercial insurance companies. At this time, Medicare does not use CAQH and only a few states use this database for Medicaid enrollment. The CAQH information can be helpful for completing Medicare applications but the provider or designated provider enrollment expert must still complete the Medicare application through PECOS.  

Think of CAQH as a secure filing cabinet that holds all the information on your practice and your physicians or other health care providers. Only participating health plans and other healthcare organizations, or a credentialing service that you authorize like 1st Assistant can access the data for provider enrollment purposes.

With 1st Assistant handling your credentialing and payer enrollment, CAQH will notify us of the quarterly required re-attestations so we can re-attest for you each cycle. We maintain your information on the CAQH database and update your license, DEA, malpractice and other expirations as they occur with information from you. When plans request access to your data for payer enrollment, we grant it for a smooth re-credentialing process – and no hassle for you! Credentialing is our ONLY business here at 1st Assistant!

Let Our Payer Enrollment Experts Go To Work for You

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.