Understanding the Council for Affordable Quality Health Care, Inc. (CAQH) as a Private Practice Therapist
Once you have completed the necessary first steps of starting your business (see here, here and here), the next major step is creating your CAQH profile.
Ah, the CAQH profile, we all know about this right? Not a chance. This is one thing I feel like absolutely no one told me about. Then one day people starting referring to this profile like I was supposed to know what they were talking about. If this is the first time you have heard of this, please don’t stress. Here is the rundown of what this confusing, yet absolutely necessary website it all about.
Why do private practice therapists need CAQH?
Likely you will be working with a number of insurance companies. Keeping track of who you have been in contact with, what information you have given, and updating every time something changes in your professional profile would be daunting. CAQH is a way to make these steps a little easier. Insurance companies pay to use CAQH, and you grant permission for these companies to view your information. This is a situation where the middleman is there to make your life easier.
The information in your CAHQ profile will include both your personal and professional details, educational background, internship locations, past employers, professional references and updated professional documents.
Every 120 days you will be propped to attest to the information provided on your profile (basically your vow that the information you have provided is true and up to date). Insurance companies that are viewing your profile can then quickly look at this information on this data base to keep their systems up to date (so you don’t have to contact everyone directly every four months!) So far, all but one insurance company I work with uses this system.
You first need to use this service when you begin your credentialing process. Have everything ready before you begin to make this easier on yourself. Update your résumé or CV, establish who your professional references are (don’t forget to ask for permission!), have your license ready, proof of malpractice insurance, office location, contact information, NPI and EIN. Depending on where you are practicing and what your credentialing is, you may need more information than this.
Just keep calm and give the machine what it asks for. The good news is that you only have to do this once; after that it is just maintaining your profile and attesting when you are prompted. I have also found that their customer service is quick to answer any questions. Visit https://proview.caqh.org/PR/Registration/SelfRegistration when you are ready to begin!
What is the history of CAQH?
The Council for Affordable Quality Healthcare, Inc., is a nonprofit organization formed by some of the nation’s largest health insurance companies. Over the last twenty years it has had the goal of streamlining businesses and healthcare to work efficiently together. As the world has become more tech oriented, administrative requirements for all parties have increased; and health IT policy need to keep up with these rapid changes in technology. CAQH works to bridge that gap, keep all parties involved on the same page, and standardize the processes required to work together. This includes providers, health plans, vendors, government agencies and standard-setting bodies. CAQH ProView is the website used and will be the interface that you will work with as a provider. In a nutshell: they regulate and mediate what everyone needs to work together.
TL;DR
Insurance companies pay to use CAQH, a middleman, to view your practice information and keep up to date records and important documents (such as your current license and your business address.)
You need to create this profile as soon as possible so you can begin contacting health insurance companies to work with.
It was created to help everyone work together; regulating interactions and requirements between providers and insurance companies.
