How To Register With CAQH

Oct
14
2010

Emily Miranda, MSW is a Licensed Clinical Social Worker in Utah who was kind enough to pass on the following information about registering with the Council for Affordable Quality Healthcare (CAQH).CAQH, Insurance, Managed Care, How To

The CAQH website states this is aImage of CAQH

free service to physicians and other healthcare providers that simplifies and improves the data collection process” for those professionals who choose to file insurance for their clients or choose to become preferred providers for managed care.”

Miranda says,

It is an online service that collects provider credentialing data so that you can more easily provide it to other insurance companies.  Just being registered with CAQH does not mean you are participating with all of the organizations they have contracts with.  However, it does allow you to release your information to participating organizations.

  • To get a CAQH provider number, you must start credentialing with a particular healthcare organization; that organization will request your participation in the CAQH Universal Provider DataSource. [Miranda started with Aetna.]
  • A list of participating organizations can be found at CAQH’s website.
  • After you start the credentialing process with a particular organization, you will receive a letter in the mail with your CAQH provider ID numberDo not lose this number. You will need it to log on and submit your credentialing information on the CAQH website.
  • Follow the instructions and complete all the information.  You do not have to do it all in one sitting, but to save the information you’ve completed and come back to finish later, you must hit the button at the bottom of the page that says “next”.  That will save the information you entered on that particular page, and all the pages prior to it.
  • After you enter all the information, you need to run an “audit” on your file to make sure that all the information is complete and correct.  The website instructs you to do this.
  • After that you “attest” all your information (you will also be instructed to do this by the website).  It will give you a message that your file is complete.  You are finished!

Be sure to save your username and password somewhere safe; you will need it to log on to the site in the future and update your information.

Emily Miranda, MSW, LCSW, thanks so much for sharing this with us!

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Comments

  1. The CAQH record is a major advancement in the credentialing process. Most major insurance companies require it as part of their procedures. Filling it out for the first time can be quite daunting however and requires a good deal of record collecting in advance. I helps to review all the information that it require and collecting that information before you begin to fill out the form. It saves a great deal of time and limits the frustration.

  2. Thanks so much for your comment! We have at least one other medical technologist in our community here. I’m glad you took time to comment and I hope you’ll be back again soon.

  3. Heya i’m for the first time here. I came across this board and I find It truly useful & it helped me out much. I hope to give something back and help others like you aided me.

  4. BCBS is now requiring all of its PPO and HMO providers to be credentialed through CAQH despite the fact that in order to have gotten enpanelled with BCBS they already were credentialed. The letter I received regarding this actually said not getting credentialed with CAQH would result in loss of provider status with BCBS.

    The directions on the CAQH website are self-explanatory. I agree with the above statement that even though it is daunting, if you have all the info they say is required, the process simply takes alot of time. The one thing I had difficulty with (my university wasn’t on the pull-down menu nor was I able to type it in) was easily resolved calling their customer service number. I received an email confirming they successfully received all my info within a few days after submitting online and faxing the addendums.

    • Hi, Darlene! Welcome to Private Practice from the Inside Out! It’s always good to have voices from the beautiful state from Illinois here! And, thanks for taking time to drop in here to let us know the new info about Blue Cross / Blue Shield!

      If you need any help building your private practice, I hope you will drop back in often to chat with us! I will enjoy sharing information and learning from you, too!

  5. Hi,
    I am trying to get my CAQH number as I was told by an interviewer that having an NPI number and CAQH number would make me more appealing to hiring companies. However, I am finding this difficult to do. I currently work where a MSW was required, not an LCSW, therefore, they are no assistance in helping me with this. Never having done this, I hit road block after road block. The link on this page says it cannot get me to the application. I am not sure where to find the correct application. The one I found looks like it is for doctors. Please help!
    Thanks,
    Michelle

    • Thanks, MIchelle, for taking the time to let me know that this link no longer goes to the correct information. Sometimes the info on websites change. I’ve just updated the link to go to the info you need to register for CAQH. Let me know if there is anything else that I can do to support you in building the business that you want.

  6. Hello. I am a licensed social worker in Maryland and trying to go back to work. I have maintained my license but have never practiced on my own, I would like to accept insurance to reach a broader base of clients but no idea where to start. I have been readin the site. Do you have to have a tax ID number before you can start this process? If so how do I do that. Then which insurance company do you recommend I start with? It sounds like I have to become affiliated with one and then fill out e big CAQH sper work to become affiliated with them all? Any and all help would be greatly appreciated. I am excited about providing a unique type of service and therefore anxious to get started!!

    Thanks, email anytime.

    Shelby

    • Hi, Shelby! Thanks for dropping in and welcome to Private Practice from the Inside Out! I can feel your excitement all the way over here! You’ll find lots of information about working with and without insurance companies here by entering terms like “insurance” or “managed care” in the search box in the left hand column.

      Additionally, you will need both an Employee Identification Number (known as an EIN) and a National Provider Identifier (known as an NPI) if you are working with insurance companies based in the United States. These links will tell you how to apply for these identifiers. Once you get them, you’ll be able to proceed with your application(s) to be a preferred provider with individual insurance companies.

      Although I used to work directly with insurance companies, I no longer choose to do so. You can read about why I made that choice here. And, here is a link to my blog series that tells you how to go about getting on insurance panels. I can’t suggest which insurance company to start with; however, I’m betting a lot of the therapists here in this community will have lots of opinions to share with you.

      Good luck with your new practice! I hope you’ll be dropping back in to chat as you continue to learn what works for your unique practice!

  7. Letitia says:

    I have been viewing this blog for awhile and have gained so much information. Thank you for creating this blog. I am transitioning into private practice and am an LCSW and was wondering if you new if I needed my “R” to get on insurance plans or are there insurance panels that will let allow me on with just my LCSW? Any information on this would be greatly appreciated. Thanks

    • Hi, Letitia! Thanks so much for dropping in here to chat and congrats on transitioning to private practice! It’s an exciting move, isn’t it?! I’m sorry that I can’t tell you if / which insurance panels will allow you to practice without your “R”. Perhaps someone else will know and drop in to share their experiences.

      Please do drop back in often and let us know how the transition goes. Perhaps there’s an opportunity for us to support you in some way?!

    • Letitia, just realized that you don’t have a gravatar. Here’s a link to instructions that tell you how to get one of those little images of you to pop up next to your comments here and elsewhere.

  8. Hi, i just want to ask if you know how i could get caqh ID. I spoke to CAQH representative and was told to register to an insurance company/ provider. is there a particular insurance provider i should get affiliated with and how long is the process. ill be working in a nephrology private practice in georgia.
    thank you in advance

    • Hi, Aileen! It’s so nice to have you here! So, you’ve got the right idea. You will need to initially apply with an insurance provider that uses CAQH. The easiest way to find that out – unless someone here offers that knowledge is to simply call the insurance companies and ask for “Provider Relations.” Someone in that department should be able to tell you if they use CAQH. If the answer is “yes,” then you will need to go through that insurance company’s application process to be a provider and THEN go through the CAQH process.

      CAQH actually uses their participating insurance companies as a weeding out tool. If not one company will take you on as a provider, CAQH assumes that you are not worth their investment of time and money to process your application.

      As for the time it takes, I have seen insurance companies approve a provide within 5 minutes (when you fill a unique need of theirs) or take as long as 5 years. Typically, it is a slow process to get approved as a preferred provider and, unless this is just a hobby for you, you will not want to wait for the final approval before continuing to build your practice.

      Aileen, you didn’t say what you do . . . . Are you a nephrologist or a mental health professional or something else? In any case, I hope you will return often and join the conversations here at Private Practice from the Inside Out. I look forward to networking with you, learning from you, and sharing what I know, too.

  9. Hi Tamara,
    I recently received my LPC and one of our office managers requested information of me to begin the credentialing process and registering for a CAQH number. One of my colleagues who’s been through the process mentioned that the credentialing process has to happen again with each agency within which I might be employed. Is this accurate information? And how long might each new employment registration/credentialing take to complete? I practice and reside in Pennsylvania. Thanks!

    • Hi, FMC, and welcome to Private Practice from the Inside Out! The short answer is . . . it depends. If your CAQH number was assigned to you personally, then your one number will suffice for you anywhere. However, if you have been using an agency-granted number (rather than your own), then that number is only good for the professional services that you provide at that particular agency. The application process varies in length and the only way I know to estimate that timetable is to contact CAQH directly.

  10. Hello,
    I’m glad I found this website! I have been doing research and my questions still didn’t get solve. I learned a lot here.
    I want to know does it have to be a practice and have a TIN in order to get provider ID’s and credential with CAQH?
    Is medicare enrollment a must for acupuncturist? Since medicare does not cover acupuncture but some medicare advantage plan do cover acupuncture; therefore I’ not quite sure if medicare enrollment is needed.

    Thank you in advance!

    • Hi, Lan, and thanks for dropping in to Private Practice from the Inside Out. I love having non-therapists show up here but I hate not having all the answers. And, this is one of those times. I’m sorry. I don’t work enough with acupuncturists who are interested in working with CAQH to even know where to point you. You’re going to have to try to find this info elsewhere.

  11. Cathleen says:

    Hi:

    I’m a Board Certified Behavior Analyst (BCBA). I started trying to get credentialed a month ago to set up my own private practice. The hardest part for me was getting an insurance company to request me for the CAQH. Aetna was the first; I had tried 4-5 different insurance companies. Maneuvering medical insurance websites is not easy when trying to look for credentialing information. I got a provider ID number within a month and my CAQH application was approved within 24 hours after I faxed the required information to them. Having gone through the multiple tedious applications with insurance companies, I had to keep googling was NPI Type 1 and II, EIN, TIN, etc., I had all the information I needed when it came to the CAQH process and it went without a glitch. At this point, because I was able to tackle 4-5 insurance companies and submit everything that I submitted to the CAQH, I’m ahead of the game. My question is, how do I expedite the process and contact other insurance companies that I’ve been unable to get credentialing applications to ask them to review my CAQH application? I’m getting passed from 1-800# number to 1-800#. It’s frustrating is there an easier way?

    • Cathleen, thank you so much for dropping in to share your experience with us. That is so helpful!

      The hoop-jumping is soooo frustrating, I know! The easiest (and I did not say “easy”) ways that I know of to get credentialed involve relationship-building – either directly by meeting and networking with managed care gatekeepers or indirectly by having new clients request that you be approved to provide their treatment.

      There is a third way that some clinicians choose to go – and that is by hiring a credentialing company to do the legwork for you. I don’t recommend this route. It is costly to do so. They often try to upsell you more services. The process of getting credentialed is not rocket science; it’s simple, just tedious and frustrating. And, these services can promise way more than they sometimes deliver. Having said all of that, I have also spoken to a few therapists who are quite pleased that they chose to hire this out.

      I know this is not what you had hoped to hear, Cathleen, but it’s what I know to be true. Hopefully, others will drop in to this older post and share different strategies that can offer more options for you. And, either way, I hope you’ll drop back in to share more about your journey in getting credentialed!

  12. Hello! I am hoping you can help me. I am a LPC and practice in Pennsylvania. I have my own NPI # and CAQH provider ID. I am currently credentialed under my current companies group. I want to open up my own practice. How do I go about getting credentialed under myself or my future companies name? Any suggestions and steps of what I need to do first would be greatly appreciated!!!

    • Some group practices get their providers credentialed as a group; others have their providers credentialed as individuals. Verify with your employer or CAQH the way that s/he had you credentialed. Your transition may be as simple contacting Provider Relations at each managed care company that you are contracted with to explain that you will be moving into a solo practice. Request that your credentialing be changed to reflect this.

      If the managed care company is not willing to change your status to an individual provider, you will need to start over with the credentialing process for each company.

      • How would I go about doing this without my employer knowing as of right now they update my CAQH info for me and all the info gets sent to them? I have access to look at it but they update it and are the contact person.

        • Hi, LPC! Welcome to Private Practice from the Inside Out! I would start by contacting CAQH directly. You don’t need to identify yourself in order to ask questions so just ask! And, because your info is already in the database, they may also be able to give you a copy of the application that has already been submitted. If not, you can see if you have an opportunity to copy the record that your employer keeps for CAQH. Just say that you were reading a post online that recommended you always keep a copy of all applications you complete for your employer and that you are now trying to instigate that practice.

          I hope you’ll drop back in after talking to CAQH / your employer and let us know how you ended up handling this situation. Best wishes!

  13. Hi Tamara,

    I am an LPC in Private Practice. I am now in the process of adding clinicians to work with my agency. I have been using CAQH for a few years now as a independent provider and am a bit confused. It appears that there is an option to have a CAQH number for my agency and add new clinicians to that. Is this an option? If this is an option, would my agency still have to initiate credentialing with an insurance company for the provider first or because my agency is already credentialed and contracted with them be able to add the provider that way?

    Thank you in advance for everything that you do. Your website and willingness to share with us is truly a blessing!

    Daphne

  14. Jessica says:

    Hi there! One question about sequencing–if I am interested in more than one panel, and am not credentialed with CAQH yet, should I apply to the one I am most interested in, then wait for the invitation to register with CAQH, then use that number to apply to the other panels?

    OR can I apply to as many as I want right away, and wait for one of them to contact me with a request to get credentialed?

    Thank you so much and I so appreciate this forum! Very helpful!

    • Hi, Jessica! Welcome to Private Practice from the Inside Out and thanks for dropping in today! There is not one “right” way to apply to get on these panels. However, I have heard several therapists say that they started with Aetna because they typically work with CAQH. What I would recommend is that you not hold your breath while you wait for paneling with any of these managed care companies. Go ahead and apply if that’s what you want to do but spend that time before you are credentialed with them learning everything you can about getting known for your niche, getting seen as a valuable resource in your community, and building trust – both face to face and online. That KNOW -> LIKE -> TRUST cycle has to happen before someone ever picks up the phone to even call you. That’s true regardless of whether or not they have insurance.

      • Jessica says:

        Tamara, thank you SO MUCH for your quick reply! That’s good to know–I just didn’t want to mess up the process with one company by starting with another one. I know it’s good to start it way in advance of opening the doors, so I was just getting that rolling, so now I can turn my attention towards other important things (developing website, marketing plan, etc).

        DEFINITELY taking your wise counsel into consideration about building trust in the community–I could not agree more. I am studiously working my way through your website, and I’d like to thank you again for being such a great resource for us all! It’s so helpful.

  15. What website do I go to,to start the registration process?

  16. IS IT OK TO LET THE NON-PROFIT, LARGE, AGENCY I WORK FOR OPEN ACCOUNTS WITH INSURANCE PANELS IN MY NAME? I don’t know how it was done before but they just announced this change. I am also beginning to work for a private practice start up in another county and wonder if this will hurt or help.

    • Hi, John! Welcome to Private Practice from the Inside Out! It’s fine for an agency to open accounts with insurance panels for your benefit. However, don’t count on that credentialing to follow you into private practice. Whether you are practicing independently at a different site while you are also working for the agency (that got you credentialed with managed care companies) or you are practicing independently after you leave the agency, don’t assume that the credential will extend to your independent practice away from the agency. It is your responsibility to confirm with each managed care company that you will remain on their panel as a provider in private practice.

      Typically, if you are already credentialed with a managed care company, when you relocate to another county (or state), you are required to notify them of this change in writing. If they perceive your relationship with them in the past to have been positive, they will happily extend your credentialing to the new location. However, if they have perceived their working relationship with you to have been difficult, they will likely use this as a reason to terminate their relationship with you when you relocate.

Trackbacks

  1. [...] Step 5 – Complete the CAQH. The application process can be lengthy and arduous. Plan on 20-30 page applications for most insurance companies and plan on about 50 pages for Medicare applications. The Council for Affordable Quality Health is an online service that allows you to complete one application that over 100 managed care companies use.  That can save you a lot of time so consider complete the CAQH to cut down the amount of paper work (potentially 2000+ pages) in the process.  (Check out this guest post on how to register with CAQH.) [...]

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