CAQH Portal and Its Role in the Credentialing Process

A Provider’s CAQH portal plays a crucial role in the credentialing process. Let’s delve into its
specifics.

For Traditional Medicare and Traditional Medicaid credentialing, the CAQH portal is not
utilized. Providers can undergo credentialing with these payers without a CAQH profile.
However, Commercial, Medicare Advantage Plans, and MCO plans require providers to
maintain an active CAQH profile during credentialing. This profile is tied to the individual
provider, not a business. One profile suffices regardless of the practice a provider works for.
Registration for a CAQH profile is done through the following link:
https://proview.caqh.org/Login/Index?ReturnUrl=%2f

Once registered, providers must complete and attest to their profile, as mandated by healthcare
insurers during credentialing. For assistance or inquiries regarding profile completion, providers
can contact the CAQH Helpdesk at 1-888-599-1771.

It’s important to note that applications to join insurance networks are not submitted via the
CAQH profile. Instead, they are directly submitted to the insurance companies. Insurances
review the credentialing application and cross-reference it with the provider’s CAQH profile to
ensure data consistency. CAQH serves as a verification database used by insurers to validate
information provided on credentialing applications.