Credentialing is an essential component in the world of healthcare, where high-paced work and consistent insurance reimbursements depend on the accuracy and up-to-date healthcare provider information. It is a highly involved process that is streamlined by the Council for Affordable Quality Healthcare CAQH ProView system, through which healthcare professionals must certify on a regular basis on their professional profile. Nevertheless, failing to meet these critical deadlines on attestation may result in credentialing lapses, withheld payments, and other insurance network exclusions.
This blog will explore the relevance of CAQH attestation reminder, discuss practical methods to establish reminders, the advantages of delegating updates, and how document management can be automated to avoid the more expensive errors required during credentialing. As a solo practitioner or a healthcare organisation, managing your CAQH attestation schedule becomes essential in ensuring it runs smoothly and your practice is not hindered by compliance with the insurance payers.
Why Attestation Matters?
Attestation in the CAQH context refers to the act of certifying that a health care provider has reviewed every piece of personal and professional information contained in their CAQH Proview profile and that it is both accurate and complete. This consists of licenses, work experiences, certifications, malpractice insurance, practice states, and others. Providers are then required to re-attest such information after every 120 days (roughly after every four months) or 180 days in certain states, such as Illinois.
The attestation is not some formal procedure, not a formality, but a legal document that certifies that your profile information is a true reflection of your current credentials and status. When re-attesting is not done in time, your profile status turns to inactive or expired in CAQH, and this interferes with the process of verification of certification by the payers to process claims. Implications are:
- Withholding of insurance reimbursements for services so far as provided
- Insurance plan delay in credentialing or recredentialing
- Probability of de-networking insurance
- Administrative cost of resubmission or even total recredentialing, requiring months
Therefore, immediate atestation has a direct impact on your revenue cycle, provider reputation, and the capacity to work with patients. By keeping an active CAQH attestation, you will assure insurers that your profile is valid and compliant.
Setting for CAQH Attestation Reminder
CAQH attestation needs to be set to reminders to avoid credentialing breaks that would likely cripple healthcare operations. CAQH ProView, as a tool, requires the providers that use it to re-attest their professional profile, typically every 120 days, to ensure their information remains verified and up to date.
The Attest Reminder Bar in CAQH ProView helps to keep your attestation progress in plain view with a message that displays prominently at the top of every page after changes are initiated to your profile. Still, the attestation stage is not yet complete. This reminder stays on every page until you complete the attestation, so that updating your profile is assured, certified, and is seen by the authorised organisations. In addition, the system depicts completion indicators on profile information and document requirements to inform providers of the process so that they are able to go through it accordingly.
- Computer Emails: CAQH will automatically send email notifications to the primary email of the provider long before the time to submit the attestation to give timely notice.
- Calendar Alerts: It is good to schedule repeated reminders in the digital calendars, intensifying around 30 days before the deadline, which act as an insurance reminder of the system messages and ensure enough time to do the review and prepare the documents.
- Credentialing Software: Tracking the attestation deadlines and sending reminders to providers and the administrative staff can be automated using credentialing management platforms that support integration with CAQH, increasing their reliability and decreasing the possibility of being overlooked.
- Credentialing Teams or Administrative Staff: When there are credentialing departments or other administrative personnel dedicated to practices, imposing an everyday attestation schedule and sending internal reminders makes sure that providers receive plenty of warning in advance.
Moreover, you have to re-attest whenever changing some data in your profile, to verify that those changes are actual. The Attest Reminder Bar is active until finalisation of the attestation upon an update and is present on every page to prohibit the process completion that is not certified.
Delegating Updates
Outsourcing the updates within the CAQH attestation procedure may serve as a helpful solution to credentialing tasks, particularly at a larger healthcare practice or a group environment. CAQH has enabled delegation to some extent, but still indicates that it is the individual provider who bears the legal responsibility for the accuracy of the attestation.
The following are major highlights on the delegation of the CAQH update, given the conventional practice and CAQH’s ability:
- Group Administrators and Delegated Users: CAQH allows the use of group administrators who may manage provider data about a group or an organisation. This allows these delegated administrators to post roster changes, documents, and manage attestation phases among a variety of providers in the group, thus making the credentialing process easy. Health systems or multi-provider practices are observed to employ this as an efficient management of information.
- Accountability of Provider: The provider is only permitted to delegate data entry and data submission, but each maintains a responsibility to verify and sign off on the accuracy of their attestation before it becomes finalised. Providers are not completely excused from the task of making a statement that the information provided is accurate and current. Delegation relieves administration but does not give away legal responsibility.
- Credentialing Specialists and Administrative Staff: A large percentage of practices have credentialing specialists or members of the administrative team log in to CAQH ProView to update profiles whenever a change is made, attach and upload documentation, and when prompted, click the attest button. The practice is recommended and common, though this should be done regularly, and providers are expected to look at their profiles to ensure their accuracy before making attestations.
- Credentialing Service Partners: Contracting credentialing services to specialised firms is also an option to ensure timely and accurate updates and completion of attesting. These services should, however, be monitored by the provider in order to ensure that it is kept within standards to ensure there is no lapse.
- The Access and Security Controls: Delegated individuals should be well-trained and only allowed to access sensitive provider data in CAQH, with well-defined practices regarding data security and compliance throughout the credentialing process.
Automating Document Management
A significant contributing factor in experiencing delays in credentialing is a lack of, or outdated, associated documentation like licenses, malpractice insurance certifications, DEA registration, and specialty certifications. This can be prevented through the automation of document management:
- Digital Document Storage: Have scanned versions of all necessary credentialing materials kept in safe cloud-based storage so that documents and certificates are ready to be pulled up and are organised by their expiry dates.
- Renewal Alerts: Establish automated alerts on changes of dates of licenses, insurance, and certification expiry to initiate updating of documents long in advance of the expiry date.
- Direct Upload to CAQH: Ensure documents get updated timely manner and new versions are uploaded onto CAQH to stay in the status of being "Authorised". CAQH only allows PDF files, so make sure documents are good.
- Connected Credentialing Platforms: A small number of credentialing management platforms connect to CAQH and assist with automatically changing document statuses, triggering necessary uploads, and adhering to strict compliance with little involvement required on the part of the user.
The automated document management enables effective attestation cycles and decreases profiling deviations that may slow down credentialing.
What Happens If You Miss It
Missing your CAQH attestation deadline has irreversible, severe consequences even before they are entered into your entire recredentialing schedule and revenue cycle.
Short-run consequences are:
- Your CAQH enrollment status becomes inactive or expires in payer systems and blocks access to information about your insurers without any grace period or advance notice.
- Insurance panels pay no more to process your applications, resulting in them being rejected and no more payments.
- Added payers delay, access to existing contracts, and insurance participation, as well as patient referral.
Possible long-term effects are:
- Termination of network status with certain insurance companies means they never want you back on their panel until you are re-credentialed.
- Having to re-do the entire credentialing procedure, which may take several weeks to months, and significantly hamper your time to bill.
- Potential of months of unpaid claims should you fail to attest during onboarding with new payers or practices, which significantly hurts the cash flow and practice revenue.
Conclusion
It is essential to sustain timely CAQH attestation to prevent credentialing gaps that cause interruptions in insurance participation and payments. Failure to meet deadlines may lead to claims being denied, delayed payment, and being dropped from payer panels. A robust recall regulation program involving CAQH alerts and calendar reminders, along with credential software and delegation, eliminates this liability. The management of documents is made even easier by automating it. Delegation helps in alleviating the workload, but the attestation is nevertheless the legal responsibility of the provider. Proactive management of your revenue cycle will also help you avoid revenue loss and concentrate on patient care. Be organised, comply, and be sure that your CAQH profile is vital to the smooth functioning of your practice.
FAQ - People Also Asks
Can My Admin Do It?
Yes. CAQH enables authors to authorise others to act on their behalf so that administrative personnel or credentialing teams can fill out the profiles and serialise the attestations. This can be especially useful in group practices or big healthcare organisations with a large number of profiles.