How CAQH Impacts Credentialing, Enrollment, and Getting Paid
If you are a healthcare provider or administrator, chances are you have heard of CAQH. But do you really know what it does and why it matters in the payer enrollment process?
CAQH is a critical tool for healthcare providers and administrators, shaping payer enrollment, credentialing, and reimbursement. When managed well, it ensures smooth operations: when neglected, it causes delays, denials, and revenue loss. Preferred HCP’s healthcare credentialing services handle CAQH from start to finish, keeping your practice efficient and your revenue steady.
What Is CAQH?
CAQH, the Council for Affordable Quality Healthcare, runs CAQH ProView, a centralized online database for provider credentials. It acts as a digital filing cabinet, storing education, licenses, practice locations, contact information, malpractice insurance, and work history. Providers submit and attest to their data’s accuracy, streamlining verification for payers.
Why Is CAQH So Important for Credentialing?
Most major commercial payers, like Aetna, Cigna, and UnitedHealthcare, rely on CAQH to verify provider information for enrollment. Over 70% of payers use CAQH ProView, accessing it for new enrollments, recredentialing, and contract approvals. Incomplete or outdated profiles delay these processes by 30–60 days, halting reimbursements and patient care access.
What Happens If You Don’t Keep CAQH Updated?
CAQH requires attestation every 120 days to confirm data accuracy. Missing this step, a common oversight for busy providers, stalls enrollment or recredentialing. Industry data shows 15–20% of claim denials stem from credentialing errors, often linked to outdated CAQH profiles. These lapses cause payer deactivations, gaps in network participation, and administrative burdens, disrupting revenue and patient access.
How Preferred HCP Simplifies CAQH Management
Preferred HCP’s CAQH enrollment services eliminate the hassle of profile maintenance. We update licenses, addresses, and insurance certificates, complete attestations as your authorized agent, and ensure profiles are current for all payers. Our team tracks credentialing timelines, cutting approval delays by weeks and preventing reimbursement disruptions. Your staff stays focused on patient care, not paperwork.
Take Control of Your CAQH Today
CAQH is more than a portal: it is key to steady reimbursements and payer relationships. Errors or missed attestations risk delays, denials, and lost revenue. Preferred HCP’s healthcare credentialing specialists keep your CAQH profile accurate and accessible, ensuring seamless enrollment. Do not let CAQH hold you back: contact us today to schedule a consultation and protect your practice’s efficiency.
