What is the CAQH database?
Asked by: Dayna Smith | Last update: April 10, 2025Score: 4.3/5 (24 votes)
What is the purpose of CAQH?
The ultimate objective of The Council for Affordable Quality Healthcare is to gather credentialing information on healthcare practitioners and make that information available to health plans and other healthcare entities in order to streamline the credentialing process.
Is CAQH the same as NPI?
No, your NPI number and CAQH number are different.
Your NPI number is issued by CMS and is a requirement for all healthcare providers that plan to bill insurance companies. CAQH is a private organization that commercial payers utilize as a centralized credentialing database.
Who has access to CAQH?
CORE Participants include health plans representing 75 percent of the insured US population, healthcare providers, vendors, government entities, associations, standard-setting organizations and other healthcare organizations.
Is CAQH mandatory?
CAQH ID Will Be Mandatory for Professional Providers' Network Participation. Later this year we are making some changes to simplify our non-delegated credentialing and recredentialing processes for professionals and to improve our provider directories.
What is CAQH?
What happens if I don't update CAQH?
CAQH update is not mandatory for medical practices. However, if you fail to respond to the notice for re-attestation, your information is no longer accessible – not even to the healthcare organizations and health plans that you have authorized to access your data.
Does everyone use CAQH?
If you plan on accepting insurance at your private practice, you most likely will need to complete a CAQH profile. However, not all insurance carriers use the CAQH profile.
What information is stored on CAQH?
CAQH collects self-reported data from providers (education, training, location, etc.). This is the information that the CAQH Provider Data Portal collects and shares with organizations the provider chooses.
How do I opt out of CAQH?
You may terminate these Terms of Service and Your Account by sending an email stating Your intention to terminate these Terms of Service to CAQH at: ITSecurity@caqh.org, with the subject line “Account Termination”.
How much does CAQH cost?
CAQH- Council for Affordable Quality Healthcare Database
The management fees are determined by the extent of engagement of your healthcare credentialing provider as well as the frequency with which the database should be updated. A basic database generally costs between $50 and $100 per month.
Is CAQH a database?
CAQH ProView is an online database managed by CAQH where mental healthcare providers can submit, maintain, and share information about their education and professional practice.
Who pays for CAQH?
There is no cost for dentists or other healthcare providers to use CAQH Provider Data. Dental plans and other healthcare organizations using CAQH Provider Data pay administrative fees and an annual fee per provider to access the solution.
Does every provider have a CAQH number?
No, participation in the CAQH Provider Data Portal is voluntary. However, more than 1,000 health plans and other healthcare organizations have requested that their network providers use the Provider Data Portal for credentialing.
Is CAQH legitimate?
CAQH is an NCQA-certified Credentials Verification Organization (CVO). Comprehensive and timely monitoring of sanctions is critical to maintaining a network of safe, capable healthcare providers.
What states use CAQH?
The CAQH Credentialing application is accepted in all 50 states, even those with unique state forms. When providers login to CAQH credentialing, the application fields are modified based on the states where they practice. This means CAQH can be used for your entire provider network across all health plans.
What documents are needed for CAQH?
- IRS Form W-9(s)
- Drug Enforcement Administration (DEA) Certificate.
- Controlled and Dangerous Substances (CDS) Certificate.
- State medical license(s)
- Various identification numbers (UPIN, Medicare, Medicaid etc)
- Malpractice insurance policy(ies)
Who needs a CAQH profile?
Who Needs a CAQH ProView Profile? All healthcare providers working in an outpatient private practice setting who intend to bill insurance as an in-network provider need a CAQH ProView Profile. Most health insurance companies require a CAQH ProView ID number to be listed on initial credentialing applications.
Is CAQH info public?
Only health care organizations authorized by a provider have access to provider data, and a provider has access only to his or her own data. The CAQH Universal Provider Datasource is designed to be compliant with all laws, rules and regulations relating to the privacy of individually identifiable health information.
What does CAQH mean in healthcare?
CAQH stands for the Council for Affordable Quality Healthcare. Established as a non-profit alliance, CAQH aims to simplify healthcare business processes through collaboration and innovation amongst health plans, providers, and related organizations.
Do nurses use CAQH?
Once a nurse practitioner becomes licensed and board certified, the NP will have to create a CAQH profile to bill through insurance parties.
Does Medicare require CAQH?
To be clear, Medicare does not use CAQH but you can use the information stored in CAQH (If updated with your current information) to aid in the completion of Medicare enrollment applications.
What happens if CAQH is expired?
Refusal of Future Contracts by Payers – Providers who have a history of lawsuits, legal penalties, fines, sanctions, lapsed malpractice insurance, and/or expired CAQH attestation may be rejected by some payers for future contracts.
Can my employer see my CAQH profile?
Yes, your employer can see that Rula has been added to your CAQH; however, they don't typically view your profile regularly.
How much does CAQH credentialing cost?
How much does CAQH credentialing cost? The CAQH Proview database setup costs between $200 and $500. Monthly management fees typically range from $50 to $100, depending on involvement. Insurance panel applications usually cost between $100 and $200.
Who runs CAQH?
Sarah Ahmad
Sarah, CEO of CAQH, is a healthcare leader and explorer with over 25 years of experience spanning operations and innovation.