- About CAQH CORE
- Operating Rules
- New Operating Rule Structure
- Eligibility & Benefits
- Claim Status
- Payment & Remittance
- Prior Authorization & Referrals
- Health Care Claims
- Benefit Enrollment
- Premium Payment
- Mandated Operating Rules
- CORE Certification
- Priority Topics
- Join CAQH CORE
- Resource Library
- CAQH ProView
- CAQH ProView for Groups
- CAQH ProView - Dental
- Provider Directory - DirectAssure
- Credentialing Solutions Suite
- COB Smart
CAQH ProView for Groups: FAQs for Health Plans
How does CAQH ProView for Groups benefit health plans?
CAQH ProView for Groups is a new enhancement to CAQH ProView that enables delegated groups to more easily and accurately share delegated provider rosters with health plans. CAQH ProView for Groups streamlines the process of sharing delegated data by using a single, standardized roster format for all participating health plans, significantly reducing the amount of administrative effort required to update, maintain and share delegated data.
By replacing the current, highly manual process with a simple centralized platform, CAQH ProView for Groups reduces opportunities for manual errors, improving the quality of data plans receive and share in provider directories and for other business needs.
How is CAQH ProView for Groups different from the rest of CAQH ProView?
CAQH ProView has long been the industry standard for collecting, maintaining and sharing self-reported data from individual healthcare providers. CAQH ProView for Groups brings additional functionality to the solution, enabling delegated provider groups to share large provider rosters with health plans.
How does CAQH ProView for Groups improve delegated provider data quality?
By enabling groups to maintain a single, standardized roster for all participating health plans, and by calculating change reports automatically, CAQH ProView for Groups dramatically decreases the complexity of keeping a different list current for each plan, reducing opportunities for human error. The Solution also reviews every group roster against more than 100 quality checks and gives groups a detailed error report. Groups must correct all errors before they can submit the roster.
CAQH ProView for Groups reduces the manual burden on plans to review and process delegated provider data. Plans receive plan-specific rosters from all participating delegated groups, in a standardized, automation-ready format.
Do provider groups need to submit different rosters for each health plan?
No, provider groups only need to submit one roster for all participating health plans. However, groups only authorize specific data within the roster for each plan to ensure that plans only see data relevant to them.
How often do provider groups need to upload updated rosters?
Provider groups submit regular updates into the system at the intervals specified in their contracts at a minimum, but almost always more frequently.
How do health plans know when groups have updated their rosters?
The system will automatically inform plans when groups have updated their delegated provider rosters.
Can our plan automate the data from CAQH ProView for Groups?
In the coming months, plans will have the option to download roster files in either an Excel or JSON (machine-readable) format for easy integration with internal systems.
How can our plan ensure that all our delegated groups are participating?
The best way is for plans to ask their delegated groups to participate; CAQH has created a turn-key toolkit to help you accomplish this. We also have dedicated staff that can work with your plan to recruit delegated groups to begin using the solution.
Does it cost anything to use CAQH ProView for Groups?
There is no cost for delegated groups to use CAQH ProView for Groups. Participating health plans do pay a modest monthly fee, per provider, per group to access the database. For more information contact your CAQH Account Manager or send a message to firstname.lastname@example.org.
How does our plan access the information in CAQH ProView for Groups?
CAQH ProView for Groups is a separate tab located within the participating organization portal in CAQH ProView. To gain access to your delegated group data, please contact your CAQH Account Manager or send a message email@example.com.