What is a CAQH provider profile?

Registering, completing, and maintaining a profile on the CAQH Provider Data Portal is completely free for healthcare providers.

Direct Fees vs. Indirect Costs

• Direct Fees: CAQH (now operating as DataSpring, powered by CAQH) does not charge individual providers any registration, maintenance, or sharing fees. The system is funded instead by the health plans and insurance organizations that access the data.
• Indirect Costs: While the platform itself costs nothing, you may spend money if you choose to hire an outside credentialing service or administrative staff to manage, update, and re-attest your profile every 120 days. Outsourced management services typically range from $50 to $2,000 depending on the scope of work.

To complete your CAQH Provider Data Portal profile, you need a mix of professional identification numbers, work history details, and digital copies of supporting documents.

Essential Identification & Numbers

• National Provider Identifier (NPI): Your individual Type 1 NPI number.
• Tax Identification: Your Social Security Number (SSN) or Employer Identification Number (EIN/TIN).
• Government ID: A copy of a driver’s license or passport.
• Other Identifiers: Medicare and Medicaid provider numbers (if applicable).

Professional Licenses & Certificates

• State Licenses: Current state professional license numbers and expiration dates for every state where you practice.
• DEA & CDS Certificates: Drug Enforcement Administration (DEA) and controlled substance certificates (if applicable to your practice).
• Board Certifications: Documentation for any specialty board certifications.
• Education & Training: Medical, nursing, or graduate school details, plus internship, residency, or fellowship certificates.

Malpractice & Practice Information

• Malpractice Insurance: Policy details (carrier, policy number, effective/expiration dates, coverage limits) and a copy of your current face sheet or certificate of insurance.
• Malpractice History: Details and dates for any claims or settlements from the past 5 to 10 years (if applicable).
• Practice Location: Address, phone/fax numbers, office hours, and billing/remittance information.
• Work History & CV: An up-to-date Curriculum Vitae (CV) and a 5-year employment history with explanations for any gaps longer than six months.
• Professional References: Names, titles, and contact information for current or former supervisors/peers.
• Hospital Affiliations: Names of affiliated hospitals and your privilege status (even if none apply).

No, not all healthcare providers have a CAQH profile.

Who Needs CAQH?

• Commercial insurance networks: Most commercial health plans (such as Aetna, Cigna, and Blue Cross Blue Shield) require participating doctors, therapists, and clinicians to maintain an active profile in the CAQH Provider Data Portal to process credentialing and claims.
• Behavioral health providers: Mental health professionals—including psychologists, licensed counselors, and clinical social workers—are almost universally required by commercial and managed care behavioral networks to have one.

Who Does Not Need CAQH?

• Purely cash-pay providers: Clinicians who do not accept insurance and operate entirely out-of-network or cash-only do not need a CAQH profile.
• Exclusive government-only payers: Providers who only treat patients through government programs like traditional Medicare (which uses PECOS) or state Medicaid programs may not need CAQH unless required by a specific state managed-care contractor.
• Non-credentialed staff: Support staff or medical personnel who do not independently bill insurance or enroll on provider panels do not need an individual profile.

Nearly all major commercial health insurance companies in the United States use CAQH (Council for Affordable Quality Healthcare) to access and verify provider data during the credentialing process.

Major Insurers Using CAQH

Over 90% of commercial health plans accept or require an active CAQH Provider Data Portal profile. Major national and regional carriers include:

• Aetna
• Blue Cross Blue Shield Association (BCBSA) and regional plans (such as BCBS of Michigan, North Carolina, Tennessee, and Horizon BCBS of New Jersey)
• Cigna / Evernorth
• Elevance Health
• Humana
• UnitedHealthcare
• Centene
• Ameritas Life Insurance Corp.

Behavioral Health Networks

Major behavioral health and mental health networks heavily rely on CAQH to review qualifications and process panel applications, including:

• Optum
• Magellan Health
• Humana Behavioral Health

Exceptions (Insurers That Do Not Use CAQH)

• Government Payers: Traditional Medicare does not use CAQH (it uses PECOS). State Medicaid programs generally use their own state-specific enrollment systems, though some managed care plans for Medicaid do accept or require CAQH. Tricare also does not utilize it.
• Certain Smaller or Specialized Plans: A small number of local self-funded employer plans, niche regional co-ops, or specific dental/vision networks may require their own proprietary paperwork instead of a CAQH profile.

Any healthcare provider who wants to join commercial insurance networks as an in-network provider needs a CAQH Number.

Who Needs a CAQH Profile?

• Medical Doctors & Specialists: Physicians, surgeons, and medical specialists.
• Advanced Practice Providers: Nurse practitioners (NPs), physician assistants (PAs), and certified registered nurse anesthetists (CRNAs).
• Behavioral Health Professionals: Therapists, psychologists, licensed professional counselors (LPCs), licensed clinical social workers (LCSWs), marriage and family therapists (LMFTs), and psychiatrists.
• Allied Health Professionals: Physical therapists, occupational therapists, speech-language pathologists, and registered dietitians.

Why You Need It

• Insurance Credentialing: Over 90% of commercial health insurance companies (like Aetna, Cigna, and Blue Cross Blue Shield) require an active CAQH ProView Profile to verify your education, licensure, and work history before approving you for their networks.
• Streamlined Data: Instead of filling out separate credentialing forms for every single insurance company, you enter your information once in the centralized database.