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?
For many practices, CAQH is one of those behind-the-scenes tools that only gets attention when something goes wrong. When it is maintained properly, however, it plays a vital role in keeping your insurance credentialing and enrollment running smoothly. At Preferred HCP, we make sure our clients never have to worry about CAQH again because we manage it for them from start to finish.
What is CAQH?
CAQH stands for the Council for Affordable Quality Healthcare. It is a non-profit organization that created CAQH ProView, a centralized online database where providers store their professional information. It works like a digital filing cabinet that insurance companies use to verify your identity, qualifications, and practice details.
Through CAQH, providers submit and manage their credentials, practice locations, contact information, malpractice insurance details, work history, and attestations confirming the accuracy of their data.
Why Is CAQH So Important for Credentialing?
Most major commercial insurance companies, including Aetna, Cigna, and UnitedHealthcare, rely on CAQH to verify provider information before approving enrollment. Instead of sending identical paperwork to multiple insurers, providers enter their data once in CAQH, and participating payers can access it whenever they need to.
If your CAQH profile is incomplete, outdated, or unverified, it can cause delays in new provider enrollments, recredentialing approvals, and participation in new payer contracts.
What Happens If You Don’t Keep CAQH Updated?
CAQH requires regular attestation, which means the provider or an authorized representative must log in and confirm that the information is accurate. This typically needs to be done every 120 days. Many providers miss this step because it is not their primary responsibility.
When attestations are missed or information is outdated, it can lead to delayed enrollment or recredentialing with payers, claim denials, deactivation, gaps in network participation, and unnecessary administrative issues.
How Preferred HCP Simplifies CAQH Management
At Preferred HCP, CAQH maintenance is included in our ongoing credentialing support package. We update your profile with new licenses, addresses, and insurance certificates. We complete attestations on your behalf as your authorized agent and ensure your file is current and accessible to every payer who needs it. Our team manages these details so your staff and providers never need to log in, troubleshoot, or worry about the process.
We also track your credentialing timelines to make sure no steps are missed and no reimbursements are delayed.
Final Thoughts: Don’t Let CAQH Hold You Back
CAQH may feel like just another online portal, but it is a critical part of getting paid and staying enrolled. Keeping your profile accurate and up to date is key to maintaining smooth relationships with payers and steady revenue flow.
With Preferred HCP, you can stop worrying about CAQH. We keep your credentialing data accurate, accessible, and ready for every payer who needs it.
