Frequently Asked Questions About CAQH

The Council for Affordable Quality Healthcare (CAQH) Universal Provider Datasource is designed to accomplish administrative simplification by gathering credentialing data in a single repository that may be accessed by participating health plans and other health care organizations. Its objective is to simplify the credentialing data gathering process and enable physicians and other health care providers to easily update their information.

Health care organizations such as health plans and hospitals evaluate physicians and other health care providers with whom they contract to confirm that the health care providers under contract are adequately trained, certified, and/or licensed to provide care.

One of the most integral parts of the credentialing process is the collection and verification of vital data from the physician regarding his or her education, training, experience, practice history, location, disclosure of any issues impacting their ability to provide care and other background information.

Credentialing involves a tremendous amount of paperwork and administrative time. The CAQH Universal Provider Datasource will greatly reduce the amount of administrative time required in this process for physicians and other health care providers.

Access and registration instructions will be sent to physicians and other health care providers as the initiative is launched in your market. You can use your personal ID and password to directly access the CAQH online database. You can transmit the completed application electronically, or you can call the CAQH Help Desk at 1-888- 599-1771 to request an application be sent by mail to complete the application off-line and then submit it via fax.

All systems are secured to ensure that only authorized providers and health care organizations can access appropriate data. 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. In addition, CAQH will comply with any applicable laws and regulations pertaining to confidentiality and security in the development of the database and the data collection process.

The CAQH database is housed in a secure Network Operations Center that is controlled by biometric hand scanners. It is limited to engineers and monitoring staff. All network traffic to and from the center is routed through redundant firewalls for complete security to the database and online systems.

Secure internet accesses to application screens, use of passwords, electronic signatures and certificates, and powerful 128-bit Secure Socket Layer (SSL) encryption are used to ensure only authenticated use of the system. Only password or PIN-authenticated users have access to their restricted data over connections that automatically encode all information exchanges. Virus detection mechanisms are used to ensure that the database and the websites are free of all viruses. Routine tape back-ups protect all volatile system data and are secured in an off-site storage facility.

There is no cost for physicians and other health care providers to use the credentialing application database. The costs associated with the design and development of the database and data collection process have been funded by CAQH through membership fees. Health plans and other health care organizations participating in the initiative pay a set administrative fee and set fees per provider to access the database. To access the database, interested organizations should contact CAQH for more information about pricing.

Yes, you are expected to complete all questions on the application. The electronic application will present the questions to you in an interview style, with logic that presents the questions that are relevant to your particular specialty or provider type. The system is designed to allow you to complete the application over time. You can stop at any time, save what you have completed, and return later to finish the process. The entire application must be completed prior to your verification of its accuracy, and before the participating health plans that you have authorized can access it.

Yes. The main purpose of the pre-population process is to facilitate the use of the application for providers by pre-filling as many data fields as possible with available information. The provider can simply validate and/or correct the pre-populated information.

You call the CAQH Help Desk at 1-888-599-1771 to have an application sent by mail. All you need to do is complete this paper copy and fax it back toll-free to 1-866-293-0414.

If you are contracted with a health plan that is not participating in the CAQH Credentialing Data Initiative, you will need to continue to deal with that organization directly, separate from the database process. Providers can, at any time, print their CAQH application and send it to nonparticipating organizations.

All health plans, hospitals and other health care organizations are invited to participate in the CAQH Universal Provider Datasource initiative, regardless of whether they are members of CAQH. If one of the health plans with which you contract is currently not participating in the initiative, please ask them to visit the CAQH website at www.caqh.org for further information.

During the initial registration process, providers will create a unique system ID number and confidential password. This user ID and password is required to access the Universal Provider Datasource to make updates and changes. The password may be changed at any time by accessing the online application website and following the listed instructions.

Because many health plans with which you do business will be using this system for recredentialing and ongoing updating of provider directory records, it is important that the database contains the most accurate and up-to-date information. This may be quickly done via online access.

If you check and attest to data four times a year, participating health plans can access current information from the database at the time of recredentialing or database updates, without having to contact you repeatedly. This will help to ensure that you continue to conform to the requirements of each participating health plan with which you contract.

The notice section of your agreement with each of the participating health plans typically requires you to communicate certain changes to your personal information immediately. Rather than contact each of these plans individually, you can enter your changes once into the CAQH database for all authorized participating plans to access. Please be aware, however, that only plans that participate in the CAQH Universal Provider Datasource and that have been authorized by you to access your information will receive any changes. You will still need to contact any nonparticipating plans directly.

Once a provider completes the application, all the information is automatically made available to authorized health plans, hospitals, and other health care organizations with whom you participate.

No. You control which plans have access to your application information. When completing the application, you will indicate which participating health plans and health care organizations will be authorized to access your application data.

If you are contracted with a health plan that is not participating in the CAQH Universal Provider Datasource, you will need to continue to deal with that organization directly, separate from the database process. Health care organizations and health plans are invited to participate in the CAQH Universal Credentialing DataSource, regardless of whether they are members of CAQH. If one of the health plans with which you work is not currently participating in the initiative, please ask them to visit the CAQH website at www.caqh.org or to call 1-202-861-1492.

CAQH provides a toll-free telephone service Monday through Friday, from 8 a.m. to 8 p.m. ET, to provide assistance with any questions you may have.