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Participating Organizations

Health plans, hospitals and other managed care organizations across the country are finding a better way to collect data from physicians and other licensed healthcare providers.

CAQH ProView streamlines the process of collecting provider data for credentialing and other business applications, yielding higher quality information than traditional paper processes. With access to comprehensive provider information, you can optimize credentialing workflows, improve provider directories and focus your organization on using data instead of collecting it.

Updated Features

CAQH ProView offers greater usability and functionality to participating organizations and providers over traditional methods of provider data collection, including:

  • Support for and data access to additional types of provider relationships (e.g., non-participating and delegated providers).
  • Providers upload supporting documents directly into CAQH ProView, eliminating the need for paper and fax and improving quality and timeliness of complete applications.
  • Providers complete and attest to multiple state credentialing applications in one intelligent workflow design.
  • Providers may self-register with CAQH ProView before a participating organization initiates the application process.
  • Enhanced data validation features against industry sources for select data (TIN, NPI, DEA), conforming addresses to the USPS standard, and comparison against the Social Security Administrationís list of deceased individuals.
  • Application programming interface (API) capabilities.
  • Access to additional provider profile information, including the addition of the CMS Disclosure of Ownership questions.

Flexibility for Unique Plan Needs

Each health plan is unique. A credentialing solution must allow plans flexibility. CAQH ProView was designed by health plans to accommodate a wide range of needs:

  • Manage your recredentialing cycles more efficiently
  • Receive credentialing information in ASCII, XML or PDF formats
  • Support is available through a toll-free support desk or via email, or through a dedicated Account Manager, to assist with getting started
  • Identify providers who have received sanctions and other disciplinary actions

Realize Efficiencies

Participating health plans have reported one or more of the following efficiencies by using this CAQH Solution:

  • Decreased average processing turnaround time by 8 - 10 days
  • Reduced frequency of returned provider correspondence due to poor address quality by 80 - 85 percent
  • Near elimination (97 percent) of new provider initial credentialing packet mailings
  • Reduced number of legacy re-credentialing mailings (e.g. savings reported by one regional plan: $75,000 - $120,000)
  • Reduced sanctions monitoring resources by 56 percent
  • Proactive notification of provider directory data (e.g. addresses, emails, languages spoken)
  • Reallocated legacy paper credentialing application storage space