The provider credentialing process seems simple, but it includes intricate patterns and daunting steps. It is a very complex process in which paperwork often gets messy, leading to claim denials and revenue loss. However, with the availability of CAQH platforms, the process has become very simple and error-free to an extent. CAQH allows insurance companies and credentialers online access to providers’ information, avoiding paperwork. This helps them to make a quick evaluation and decision of the provider’s credentialing application. CAQH attestation & maintenance is a very important step to comply in order to make your information legitimate and available on the CAQH platform.
In this article, we will learn about CAQH attestation and maintenance service, its importance and time for re-attestation. We also discuss CAQH attestation requirements and steps behind this process.
What is CAQH Attestation & Maintenance Service?
Before developing deep into the discussion about attestation and maintenance, it is important to know what CAQH is. CAQH (Council for Affordable Quality Healthcare) is a non-profit organization that helps healthcare professionals in terms of data security and storage. It provides platforms where healthcare professionals upload their profiles, which contain all kinds of information about the provider’s personal and professional credentials. Because of CAQH, providers don’t need to write separate applications wherever they apply for a job or contract. They just share their CAQH profile link, and the concerned party can check their profile. It has reduced paperwork, writing errors, and the complexity of the credentialing process.
CAQH maintenance is a term that describes professional information on CAQH ProView is fresh which is reflecting practice as a healthcare professional. As medicine is an ever-evolving and growing field, healthcare professionals always strive to attend new seminars and training programs. Therefore, it is important to update new certificates and licenses on the website. To maintain the CAQH profile, don’t miss re-attestation reminders and comply with CAQH re-attestation policies and regulations.
CAQH Attestation Requirements
There are several key requirements that need to be followed for CAQH attestation:
- Personal And Professional Information: This includes complete legal name, contact details, address, education, training, and practice history.
- Licensure And Certifications: State licenses and board certifications should be mentioned as per state rules.
- Insurance And Liability Coverage: Details about liability insurance policies should be mentioned on CAQH profile. This includes policy limits and expiration dates. Liability insurance protects healthcare professionals and concern organizations from legal penalties in case of any mishap.
- Practice Information: Office addresses, phone numbers, hours of operation, tax identification numbers, and National Provider Identifier (NPI) is provided. There is a standard format for each section on CAQH. providers just need to fulfil correct information and follow instructions.
- Supporting Documentation: This includes diplomas, certifications, insurance declarations, and hospital privileges. Sometimes, driving licence, passport and medical fitness certification is also needed.
Steps For CAQH Re-Attestation Process
There are a few basic steps that every provider should keep in mind while practicing in an office or healthcare organization. Re-attestation after a specific time is very important to verify that information is still valid and correct. If a provider fails to re-attest their CAQH profile, it can lead to claims denials and financial instability.
1. Receive Reminders
While setting CAQH profile, there is a section for email and other contact information, you receive notification on that mentioned email after every 120 days of profile update. These reminders are sent for re-attestation.
2. Review Profile & Update
After receiving a reminder, providers need to go to CAQH ProView, verify previous information and update new data like licenses, certifications, new degrees if any. Focus on key features like contact information, practicing address and insurance information.
3. Submit Re-Attestation
Once every piece of information is updated, providers need to recheck each piece of information in order to avoid false information. Wrong information can bring providers into trouble, and a lot of time is wasted on apology and rectification applications. Then, click on the submit option and make it online for use. Providers should also keep proof of re-attestation for future use.
4. Provide Access
It is a private profile and only limited people have authority to review and use that information. Providers need to give access to concerned parties like payers and credentialers to undergo the CAQH credentialing process.
How Often Does CAQH Need To Be Attested?
CAQH has a rule of sending reminders to providers every 120 days to re-attest their information and verify that every piece of data is current and available for use. It is not possible to miss or forget the re-attestation cycle because reminders are sent automatically to providers’ contacts.
During each re-attestation cycle, it is mandatory for providers to go through each section carefully to recheck the previous information as well because technical glitches may also result in data loss. If there is any discrepancy, it should be rectified as soon as possible. In case of technical glitch, providers need to send feedback or complaints to the CAQH ProView helpline to get the issue resolved.
Benefits of CAQH Attestation and Maintenance Service
Compliance & Reduced Errors
After submitting and updating professional information for the first time, why is there a need for re-attestation and maintenance of profile? Answer is very simple and obvious as providers are always in the learning process and receive new certifications and licenses. Previous license and insurance policies also become outdated with passage of time.
So, there is always a need to add new information and remove previous updates information to give better understanding about the provider’s clinical skills and practice. Errors in credentialing process by payers are reduced and updating information after every 120 days helps providers to comply with state policies about data management.
Increased Efficiency & Time-Saving
Re-attestation and maintenance are useful for credentialing committees as they don’t need paperwork and traditional primary source verification by contacting issuing bodies separately. This increases efficiency and saves valuable time, which can be invested in the welfare of patients.
Reduce Administrative Burden
Reduced paperwork, automatic primary source verification, fewer writing errors, and quick decisions are key factors that lighten the workload. This also leads to more work and fewer resources. Eventually, administrative burden and financial costs thanks to CAQH attestation and maintenance.
Data Privacy & Security
CAQH is a well-reputed and efficient platform for data management and use. It has helped a lot in the credentialing process. Data is totally private and available only to limited persons, as the provider allows. Accurate and fresh data is available with complete security. No one has access to use and modify information except the provider. This way, data privacy and security can be enhanced using CAQH for different processes in the healthcare industry.
Conclusion
CAQH is an organization that helps healthcare professionals manage data and privacy. It is useful in streamlining the credentialing process and making accurate information available to the credentialing bodies. CAQH ProView is a platform where providers register and update their professional information. This profile can be used as a source of information wherever providers apply for credentialing. Profile access is provided to the credentialers so they can use the data for the credentialing process. CAQH attestation is a necessary step in making a profile.
CAQH attestation means verifying that every information available on ProView is correct and can be used. How often does CAQH need to be attested? CAQH Proview sends reminders every 120 days to re-attest information and update new data. Healthcare providers need to take care of attestation and re-attestation steps to show compliance with state policies. In case of delay in attestation, the credentialing process can also be delayed, and claims can be rejected. To avoid such penalties, buckle up for CAQH attestation and maintenance.
FAQ - People Also Asks
CAQH stands for Council for Affordable Quality Healthcare, and it is a non-profit organization formed with the collaboration of health plans and other associations. Its aim is to streamline the healthcare business and protect providers’ data. You may also read this blog to know more about CAQH.
Yes, providers can seek guidance from CAQH ProView help centre or experts in case of any problem. You can send your query to the help centre for a solution. There are also tutorials available on websites which help to understand the process of data submission and re-attestation. Experts are also available on email or phone call for clearing queries about data management, technical issues and profile updates.
If the provider misses the re-attestation deadline, then his information will not remain fresh. His account can be flagged or outdated, leading to a bad impact on the credentialing committee. In this scenario, providers may not be credentialed by health plans.