What Is CAQH Credentialing? A Complete Guide for Healthcare Professionals

Credentialing and enrollment are critical processes for healthcare organizations, but managing countless forms and requirements can be overwhelming.

Historically, credentialing and provider enrollment have involved a mountain of paperwork. Each health plan required providers to submit extensive documentation—from licensure and training to demographics and practice history—every few years.

That’s why the Council for Affordable Quality Healthcare (CAQH) launched its online central online database in 2002. This created a single, centralized source for provider data, streamlining what was once a fragmented and inefficient system.

While the process is simpler, it remains complex and highly regulated. To help clarify CAQH credentialing, we'll break down what it is, why it's essential for onboarding and payer enrollment, and how your organization can manage the process efficiently. We'll also address common pain points and show how a trusted partner can accelerate enrollment and ensure your workforce is ready to deliver care.

What Is CAQH?

CAQH is a nonprofit alliance of health plans and trade associations that develops tools, most notably CAQH Provider Data Portal – formerly known as CAQH ProView – to simplify and standardize administrative processes in healthcare. There are more than 4.8 million provider records in the portal, and approximately 80% of physicians trust CAQH to share their data with the nation's health plans via this secure, centralized portal.

CAQH credentialing refers to providers using the CAQH Provider Data Portal to create a central, online profile with their professional data (i.e., licenses, education, work history, etc) that they can update and “attest” to every 120 days. Participating health plans and networks can easily access the data to verify providers’ qualifications, allowing for faster network credentialing and reduced paperwork.

Providers and group administrators enter data just once, and that data is then securely shared with designated payers (CAQH Credentialing Suite). Efficient enrollment directly impacts provider readiness, reimbursement speed, and patient access.

A single source of truth

CAQH ProView standardizes and centralizes provider data with a uniform application format aligned with national standards. This reduces variations in how organizations collect, store, and share data.

More accurate information

Payers pull data directly from CAQH ProView (rather than relying on fragmented applications as in the past). And providers maintain accuracy and compliance by regularly attesting to their information, ensuring payers have current, verified data.

Faster onboarding and claim submission

Enrollment teams use CAQH ProView data as the starting point for network participation applications, supporting data collection for payer enrollment, credentialing, and provider directory management. By reducing administrative delays, the platform streamlines the onboarding process, allowing providers to see patients and submit claims sooner, thereby improving both access to care and revenue flow.

Why using CAQH matters in healthcare

Incomplete or inaccurate enrollment can lead to delayed reimbursement, staffing timeline disruptions, and gaps in care delivery. Fortunately, CAQH ProView has revolutionized the process at multiple levels.

Provider level:

• One submission versus many
• Fewer forms and follow-ups
• Faster onboarding and claim submissions
• Greater control over personal data
• Quicker access to patients and more time for patient care

Organizational level:

• A single, centralized source of data
• Fewer manual steps and opportunities for error
• Faster verification and enrollment
• Easier compliance with standards
• Reduced administrative costs

Health system level:

• Better interoperability
• More accurate directories
• Stronger compliance
• Greater trust across stakeholders
• Standardized national platform
• A more connected, efficient healthcare system

Who Is Required to Use CAQH?

There is no federal mandate requiring providers to use CAQH ProView, but most commercial payers require providers to have a CAQH ProView profile as part of their credentialing process. In many cases, administrators and credentialing specialists will assist providers in maintaining their profiles. Providers who qualify to use ProView include a wide range of clinical and allied health professionals, including physicians, nurse practitioners (NPs), physician assistants (PAs), certified registered nurse anesthetists (CRNAs), registered nurses (RNs), therapists, registered dieticians, behavioral health providers, respiratory therapists, and many others.

Key Components of the CAQH Profile

The CAQH ProView profile centralizes the information healthcare providers need for enrollment and network participation, eliminating the need for multiple paper applications.

CAQH ProView profiles contain:

• Personal demographics: Name, National Provider Identifier (NPI), date of birth, sex, languages spoken
• Licensure and identifications: State licenses, DEA number, board certifications, malpractice coverage
• Education and training: Schools, residencies, fellowships, completion dates, diplomas
• Practice information: Addresses, tax ID, hospital affiliations, billing contacts
• Work history: Employment history, gap explanations
• Disclosures: Disciplinary actions, malpractice claims, sanctions
• Document uploads: Licenses, certifications, curriculum vitae, insurance
• Attestation: Update and confirmation of information every 120 days

The CAQH Process: Step-by-Step

Setting up your CAQH ProView account may seem time-consuming at first, but it streamlines future enrollment processes and saves time in the long run. By following these six steps, providers can ensure accurate, accessible data for credentialing and enrollment and simplify interactions with health plans.

1. Create a CAQH account

• Visit https://proview.caqh.org/PR/Registration/SelfRegistration
• Click "Register here."
• Enter name, address, provider type, SSN, NPI, DEA, license info, etc.
• You'll receive a CAQH ID via email.
• Click the email link, enter your CAQH ID, and add your identifying numbers.
• Create a username and password and answer the security questions.
• Accept terms and click "Create Account."
• Return to the CAQH portal and log in with your new credentials.

2. Enter and upload all required information

• From the home page, select "Profile Data."
• Fill out all required fields (marked with a red asterisk).
• Save your work frequently.
• Red fields indicate missing data, and all fields must be valid for 100% completion.
• Refer to the FAQ link for help.

3. Authorize payers to access your information

• Specify which organizations are authorized to access your data.
• Choose global or selective authorization.
• You can also allow limited data access for non-affiliated plans.
• To work with new plans, contact them and ask to be added to their roster.
• You can update authorizations at any time in the portal.

4. Submit electronic signature attestation

• Click "Review and Attest" to finalize your CAQH profile.
• If there are errors, click "View Errors" and fix the fields.
• Review your data summary and click "Attest."
• You will receive a confirmation email within 48 hours once the documents have been approved.

5. Maintain and reattest every 120 days

• Reattestation is required every 120 days to ensure your data is accurate.
• Enter updates under "Profile Data" and upload any new documents, as necessary.
• Click "Review and Attest."
• You will receive a confirmation email within 48 hours once the documents have been approved.

6. Respond to any payer follow-up or corrections

• If you receive requests for corrections or follow-ups, log in to your profile.
• Upload missing or corrected documents.
• Verify all details, then save and reattest.

Common Challenges in CAQH and How to Avoid Them

Despite the efficiencies created by the CAQH ProView system, there are a few common pain points. These complications can slow enrollment, delay reimbursement, and impact patient access to care, so it's critical for providers to be proactive and avoid these pitfalls.

Incomplete or inconsistent data entry

Incomplete or inconsistent data can derail the enrollment process and lead to denied claims and delayed payments. Fortunately, CAQH ProView has a built-in data verification tool. To use this tool, providers can log in to ProView and click the "Review and Attest" button, which will run an automatic review. The Review page will identify any required or suggested fixes, such as mismatched names or dates, outdated information, or gaps in employment history. Providers can then update the data and reattest to the new information.

Failing to reattest every 120 days

Missing the 120-day deadline renders a profile inactive and can lead to enrollment delays and rejected claims. Users will receive automatic notifications for upcoming deadlines, but setting additional calendar reminders to track deadlines can help ensure compliance.

Delays in uploading documentation

All documentation, including insurance, licenses, and DEA certificates, must be current and correctly uploaded. If not, the file will be flagged as incomplete, and processing will be paused. Furthermore, documentation must align with information in other databases, including the NPI registry and state licensing boards. Additionally, uploaded files that are illegible or in unsupported formats will be rejected, leading to delays. To avoid these issues, providers can watch for email notifications, contact CAQH support, and prepare all necessary documents in advance of submitting an application.

Neglecting to authorize all relevant payers

Forgetting to authorize payers means that payers cannot access the information needed for enrollment. As a result, billing will be disrupted, and claims will be delayed or denied. If you’ve neglected to authorize payers when setting up your profile, you can visit ProView, navigate to the "Authorize" section, select global or the specific organization authorization, save, and reattest the profile. Next, contact the payer to confirm they've received authorization and are processing your application.

Difficulty integrating CAQH data into internal systems

In some cases, health plan systems may encounter difficulties integrating with CAQH data. These interoperability problems can be attributed to fragmented systems, inconsistent data standards, slower integration, a lack of technical expertise, inadequate infrastructure, or insufficient resources. To address these challenges, organizations can ensure system compatibility, utilize a single, integrated system, implement data mapping, and employ software that directly integrates with CAQH.

How CAQH Impacts Provider Readiness and Revenue Cycle

Credentialing and enrollment are key parts of broader operational and financial priorities. And healthcare executives are aware of the downstream effects of smooth versus bumpy credentialing and enrollment processes. Delayed credentialing leads to delayed payer enrollment, which in turn results in a delayed ability to bill, leading to delayed revenue. Conversely, accurate CAQH management means faster payer approval and quicker start dates for providers. Furthermore, improved provider data accuracy leads to more effective patient scheduling and access management.

How HealthStream Supports Provider Credentialing and Enrollment and Readiness

HealthStream's suite of workforce readiness and onboarding solutions, including CredentialStream and CredentialMyDoc, integrates with provider onboarding workflows, features tools that track credentialing milestones, and provides education aligned with compliance and licensure needs. Medical groups across the nation trust HealthStream to play a critical role in supporting operational efficiency, greater productivity, and regulatory assurance.

Our solutions encompass everything organizations need to request, gather, and validate information about providers, creating a sole source of truth to support downstream processes. HealthStream enables administrators to master all aspects of credentialing and enrollment by streamlining forms, securely storing and organizing provider data, staying on top of important dates, and automating processes.

Tips to Help Employers Manage CAQH Efficiently

While providers are ultimately responsible for maintaining their own CAQH ProView profiles, medical groups, private practices, hospitals, and credentialing teams can take the following steps to help with the process:

• Keep a checklist of all CAQH profile elements
• Set reminders for quarterly reattestation
• Maintain a secure, central document repository
• Standardize internal file naming and documentation formats
• Create a credentialing intake form for new hires to help ensure consistency
• Proactively monitor upcoming renewals (licenses, CME, etc.)
• Actively manage authorizations
• Centralize credentialing across health system departments
• Create an in-house guide to CAQH procedures and train staff
• Utilize credentialing software and tools that integrate with CAQH

Credentialing and Enrollment Are the Gateway to Provider Success

CAQH is critical to ensuring providers can deliver timely, high-quality care. To support effective enrollment, providers and organizations must treat it as a strategic function, not just a compliance task.

HealthStream is dedicated to facilitating streamlined and integrated workforce development, helping organizations improve accuracy, boost efficiency, and focus on delivering the best possible patient care.