How CAQH Impacts Credentialing, Enrollment, and Getting Paid
CAQH, the Council for Affordable Quality Healthcare, provides a centralized database that allows healthcare providers to store and update key professional information for payers. Many insurance companies rely on CAQH because it helps streamline credentialing, directory management, and provider verification. This reduces paperwork, prevents repeated requests for the same documents, and supports faster processing.
Source: CAQH Provider Data Portal Overview
At Preferred HCP, we work with CAQH every day while managing credentialing and enrollment for providers. Our team has seen how CAQH directly affects timelines and reimbursement. Many practices come to us with profiles that have missing documents, outdated information, or expired attestations, and these issues often lead to avoidable delays with payers. Once the profile is corrected and kept current, the enrollment process typically moves more smoothly and providers experience fewer interruptions related to credentialing.
Why CAQH Matters
The CAQH Provider Data Portal, formerly known as ProView, is used by more than one thousand health plans and millions of providers nationwide. Payers access CAQH to verify identity, education, training, work history, malpractice coverage, and other essential information. When the profile is complete and up to date, payers can process credentialing requests more efficiently.
Source: CAQH Participating Organizations
CAQH supports secure document storage and controlled authorization, allowing payers to access only the information providers choose to share. This system helps credentialing departments trust that the information they review is accurate and current.
The Importance of Attestation
Providers must log into the CAQH Provider Data Portal and re-attest every 120 days, even if nothing has changed. CAQH sends automated reminders as the deadline approaches, and if a re-attestation is missed, the profile becomes inactive and payers may no longer rely on its information. This can lead to processing delays, interruptions in network participation, or requests for resubmission.
For practices that depend on steady reimbursement, missing a CAQH attestation can have serious operational consequences. A single expired attestation can slow down enrollment, delay claims, or trigger avoidable back and forth with payers.
How CAQH Affects Enrollment and Reimbursement
When CAQH information is outdated or incomplete, credentialing teams may pause or deny enrollment requests. This can result in:
- Delays in effective dates or network approval
- Claims being held because payers cannot verify credentials
- Revenue loss while providers wait for confirmation
- Longer onboarding timelines for new hires or new locations
Research from MGMA shows that credentialing related data issues contribute to administrative denials and payment delays across the healthcare system.
Source: MGMA Stat
Keeping CAQH current is one of the simplest ways to reduce these issues.
How Preferred HCP Helps Providers Avoid CAQH Problems
Preferred HCP has more than fifteen years of experience managing credentialing and enrollment for healthcare organizations of all sizes. Our team supports CAQH upkeep in several ways:
- Profile setup and verification so nothing is missing
- Authorization management to ensure the correct payers have access
- Monitoring of all re-attestation requirements
- Prompt updates when a provider adds new locations, licenses, or affiliations
- Prevention of delays linked to expired documentation
From our daily work with diverse practices, we have observed that proactive monitoring helps prevent common pitfalls such as overlooked authorizations or outdated documents. This level of attention helps providers avoid unnecessary administrative problems and protects revenue that might otherwise be delayed.
How to Keep Your CAQH Profile in Good Standing
Providers can maintain a healthy CAQH profile by following a few simple habits:
- Log in every 120 days to re-attest even if nothing has changed
- Keep digital copies of licenses and insurance documents ready for upload
- Review profile access to make sure authorized payers are listed correctly
- Update practice locations, contact information, and affiliations as soon as they change
These steps support smoother credentialing and reduce the risk of interruptions.
Final Thoughts
CAQH is a valuable tool for payers and providers. When it is maintained properly, it helps credentialing move forward without unnecessary delays. When it is neglected, it can create disruptions in enrollment and reimbursement. With the right support and consistent upkeep, CAQH becomes a helpful part of the credentialing process rather than a barrier.
FAQ – CAQH Provider Data Portal & Credentialing
Q: How often do I have to re-attest in the CAQH Provider Data Portal?
A: Every 120 days, even if nothing has changed.
Q: What happens if my CAQH re-attestation expires?
A: Most payers will freeze enrollment applications and may place claims on hold until the profile is active again.
Q: Can someone else manage my CAQH Provider Data Portal for me?
A: Yes! Preferred HCP handles setup, updates, authorizations, and re-attestations for providers nationwide.
