TreSource

Introduction

You may have heard of the CAQH ProView registry and may understand that you have one. Yet for many, their CAQH account remains a bit of a mystery. This article will review what it is, what it's for, why you need it, and how to set up or manage your account.

What is it?

CAQH stands for Council for Affordable Quality Healthcare and is a free, secure database for healthcare providers to self-report professional and practice information to payors, hospitals, large provider groups, and health systems. For example, your demographics, education and training, work history, malpractice history, and other relevant credentialing information for insurance companies to access. 

What is it used for?

CAQH does not submit applications to insurance companies or complete the credentialing process for you but they do play an important role in the process. CAQH may eliminate duplicative paperwork with organizations that require provider profile information for claims administration, credentialing, directory services, and more. Various documents, such as your certification, license, and liability insurance routinely expire, and rather than provide each payor with updated documents, you can upload them into your CAQH profile, attest to their accuracy, and grant payors permission to access the files.

Why do I need one?

If you are working with an insurer as an independent ABA provider or through an employer then you will likely need a CAQH account. The CAQH database can be accessed by any health plan in all 50 states and may be a requirement in your state. Insurance companies often utilize the database during the credentialing, re-credentialing, and auditing process.

In the event participation in CAQH is voluntary, registration is highly recommended. CAQH streamlines provider data collection, so participation is requested by many insurance carriers and healthcare organizations.

How do I create an account in the CAQH database?

1. Have all of your documents ready for uploading. This includes a copy of your BACB certification, license, liability insurance, curriculum vitae, W-9, and diplomas.
2. Have three professional references as these are required for your application.
3. If you’re starting an independent practice then you’ll also need information about your entity. This includes legal entity name, TIN, address, phone/fax number, Type II NPI number, hours of operation, billing company information if outsourcing, credentialing contact information (which may be your info), and contact email address. Be sure that the email address listed will reach you as CAQH will use it for notifications, including password resets.
4. Once all documentation and information have been gathered,  go to https://proview.caqh.org/PR/Registration/SelfRegistration. 
5. Complete the online application and review the data. Authorize access to the information for any health insurance agency you plan to contract with. After all the data has been entered, verify the data and/or attest to it. 
6. Upload and submit supporting documents for approval. 
7. Save your CAQH ID #, user id, and password in a safe location. It is not recommended that you share this information with others.
8. Reattestation is required every few months. Complete this process in a timely manner since participating organizations will not be able to access a provider’s information until the process is completed.

For more information on how to complete an initial application, go to https://proview.caqh.org/PR/Registration or check out the CAQH ProView Provider User Guide available in the Downloadable Tools.

What could I do if my employer created my account?

It is not uncommon for an employer to assist in the creation of a CAQH account as they’ll likely need you to have one in order to complete your credentialing within their network. In this case, your employer may ask that a specific insurer have access to your profile in order to complete the credentialing, re-credentialing, and auditing process. However, it is important that you maintain full control of your account by keeping the username and password protected and the contact email address as your own. This will ensure all correspondence from CAQH regarding your account is sent directly to you. It will also allow you to access the account at any time to update and/or attest to the information listed and change your password as needed.

If you have an account but do not have the username or password, then it is recommended you retrieve this information as soon as possible. It is your responsibility to update and attest the information is accurate. In the case of starting your own practice, you will need to add your practice information to the account in order to begin the credentialing process with many insurers. Keep this in mind as anyone who has access to your account, such as your employer, will also be able to see when you have added information.

What to do if I'm not ready for my employer to know I'm starting an independent practice?

Requesting to have sole access to your account or adding your business information may raise a "red flag" to your employer that you intend to leave. If you aren't ready to have this conversation, then it is recommended that you develop a plan for disclosing your goal of opening an independent practice. Being prepared will help you to have a proactive, rather than reactive, approach to your future relationship. For more information on how to address this potential situation, refer to the recommendations outlined in the blog How to Break-Up With Your ABA Employer available here: LINK

Written September 2, 2022 - By Charity Steele, MS, BCBA