CAQH and the Physician

by Marcy Riviezzo

The best way to describe CAQH comes directly quoted from their website:

“The Council for Affordable Quality Healthcare (CAQH) is a council of 25 of America’s largest Health plans and insurers and three of the principal health plan associations working together to help improve the healthcare experience for consumers and physicians. CAQH member health plans have more than 110 million Americans and 600,000 providers in the networks.”

It is the standard credentialing source for over two hundred healthcare plans. It maintains the UPD (Universal Provider Data Source). All information you provide to the Universal Data Source is maintained through encrypted technology.

If you are contracted personally or perhaps with a hospital or group, chances are someone in your administrative staff has created a profile for you on CAQH/UPD.

Here’s WHY it matters:

ALL major insurance health plans access your profile regularly to keep your contracts and credentialing or recredentialing updated with information such as a copy of your current medical license, DEA License and Malpractice Insurance, just to mention a few requirements for you to practice medicine. The encrypted technology allows CAQH to streamline your data storage and manage it for distribution to all health plans and networks for easier contract applications and renewals. It is important that all physicians and mid level practitioners keep a current profile of their data for easy access.

Every six months CAQH emails a request prompting you to review and submit any new updates or renewals of information. Many of your contracts renew at the beginning of the new year and will want to access CAQH regarding your profile, so now is a great time to be proactive and contact or call CAQH to ensure you are current!

Annual updates to your profile include renewal of your Medical License, DEA license, malpractice insurance, BLS or ACLS, TB skin test, your current practice location and any hospital affiliations.

If you do not have a CAQH ID number and profile, I encourage you find someone to help you to create your CAQH/UPD as it can be frustrating and time consuming to complete it on your own. It is basically a process of gathering your professional profile but is usually an extra task that does not fall into a priority list of our day-to-day activities — so often times this just doesn’t get done. Once you get behind, it takes much longer to catch up.

If you have any questions regarding CAQH please do not hesitate to contact me directly to chat about helpful hints to keep CAQH on your priority list! I can be reached directly at 719.232.5566.