Improving Health Plan Provider Directories Q&A

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Questions about CAQH ProView

Where can I update my email so when I have to update any providers it'll be sent to the correct email? I have the correct email under my title as Credentialing Administrator. I don't know where else to add my email.

Providers should log in and review the email addresses on their account. They can make changes and attest when necessary. 

The liability insurance address automatically showed up on the review page and was incorrect. Do I just go with that since it would not allow me to change it?

Providers can select "Other, Not Listed" and enter their own values.

As an indirect provider (radiology) I'm never clear what "Location" should be disclosed? Is it only locations that our providers are physically at or all locations we provide services for?

The Practice Location section in ProView is designed specifically for locations where a provider sees patients. Providers may enter other locations, utilizing the Practice Affiliation dropdown to communicate the affiliation at that location.

We have a lot of locums that come through our multispecialty clinic. I am only able to update information on the provider regarding our clinic, though there may be multiple employers listed that don't appear to be updating information and show with errors that I have no information on. Do I just leave the errors or do I remove the other place of service and just make certain ours is correct?

Providers should review the information on their account and update any locations that are no longer valid, then save and confirm.

How can you complete a group of 14 physicians at one time? We have four offices I have to keep completing for four offices and all 14 physicians.

With ProView for Groups, provider groups can generate delegated rosters, confirm directory data and even push location information to individual provider profiles. 

The CAQH ProView Practice Manager Module enables office information to be entered one time for multiple providers. There is no need to fill out redundant information for each healthcare provider practicing in your office. For more information visit our ProView for Groups page.

I want to make sure all the past LLC enrollments and claims processing is completely shut down and new can be set up, appropriately.

Please contact your payers directly to confirm your enrollment and claims status.

We are receiving many request from the payers requesting that we validate the providers information that is also housed in CAQH. Is this going to be mandated that the payers utilize CAQH to obtain the providers information?

Perhaps this request is being mandated by your payers? You should contact your payers for more information.

Would having a practice manager CAQH account cause an issue for individual provider CAQH accounts? How are you able to find out if your organization has  a practice manager account? Would multiple information that would being submitted cause errors for all insurance plans?

Visit our ProView for Groups page for more information.

We can't expect Plans to know a Provider has left if CAQH does not have features to track that Provider left the group and wants to Opt Out OR provider will maintain their own data. Fields need to be added so that we can update without calling! Less errors if you add these fields.

The ProView Provider Status is displayed in all of our solutions. Through the ProView for Groups solutions, separate provider profiles can be maintained by the group and the provider. Groups can term a provider from their group at anytime which will be shared with the authorized plans to notify them that a provider has been termed from a group, location, or individual health plan. 

I have providers with other practices in other states. The provider's CAQH info for my NJ practice has been updated, but I cannot upload his cert. of malpractice because the other practice hasn't updated his NY License. Why is that? His other practice should not be stopping us in NJ from doing our job.

The providers should log in to ProView and ensure their practice state information is up to date. Once it is updated, they should save and attest, this should remedy the inability to upload documents.  If additional assistance is needed, please have the providers contact our Help Desk via the chat feature in ProView.

Do we need to delete documents that are being replaced?

Providers do not need to replace expired documents when they upload a new one.

Are there different solutions based on if the provider is under a delegation arrangement for credentialing vs someone who is not?

Yes. ProView for Groups allows practice managers to manage their delegated rosters.  For providers who are not under a delegated arrangement, they can continue to use ProView to manage their professional profile. Visit our Proview for Groups page for more information on managing delegated rosters.

I have a group of providers however, some are not a member of our network. Do I need to list their names?

For Delegated Credentialing Oversight: ProView for Groups allows you to control which plans have access to your provider information and get automatic notifications when those plans have downloaded your delegated roster.

We have been advised that even our banking information for EFTs must be updated on CAQH. There is no area that asks for this information, please advise.

We recently sunset our solution for EFTs. Please work directly with your payers to set up EFT.

Our group does not know which payers are querying our provider data from the group profile or the individual provider profiles. How do we decide whether to change to the Proview Group option?

With ProView for Groups, you control which plans have access to your provider information and get automatic notifications when those plans have downloaded your delegated roster.  For more information, visit our ProView for Groups FAQs page.

CAQH requires a practice location. Insurance plans who use CAQH require a practice location loaded. Our Urgent Care Providers use CAQH database.  The Urgent Care provider should not be listed in insurance provider directories.  How can this be resolved on CAQH to make all parties involved get the information they need?

Health plans (insurers) are responsible for curating their provider directories. Providers should make use of the Practice Affiliation dropdown to explain their affiliation with a given location. Please consult the resource section of CAQH ProView for additional details or contact our Help Desk via the chat within the portal.  

What does CAQH have to offer regarding rosters?

Great question! Many of our provider data solutions (e.g., VeriFide, DirectAssure, and ProView for Groups) accept rosters. Health Plans can roster providers for credentialing, delegated credentialing oversight, and directory use cases. For more information, contact a member of our Provider Data Management Team at Sales@caqh.org.

Why are applications not automatically sent to designated insurers?

Health plans (insurers) designated by providers to receive their information can export provider profile information. It's the health plans discretion when they export the information.

What if our providers belong to multiple PHOs and we have multiple companies at each address.  Should the providers be listed under all companies at all addresses

The Practice Location section is designed specifically for locations where a provider sees patients. Providers may enter their locations and utilize the Practice Affiliation dropdown to communicate the affiliation at that location.

Will the CAQH ProView system change its re-attestation timeframe to comply with the No Surprises Act (e.g., re-attest every 90 days)

The re-attestation timelines will remain at 120 days. However, to meet the January 2022 NSA requirements, providers must log in to ProView and confirm their practice location information every 90 days.

Why can't we update our information on CAQH only and then the payers update from that site?

This is precisely the behavior we are encouraging.  

Is CAQH looking at doing any master location record that can be hooked to providers so when it updates, it can update for all MDs if they approve?

Great minds think alike. We are actively developing this feature.

Will CAQH consider working with industries that do not work by practitioner like Durable Medical Equipment?

Yes. We are currently developing credentialing services for facilities. There are other industries we are exploring, we'll add durable medical equipment to the list; thank you.

I've been having rejections when I upload a board certification stating it is not required by health plan. I get requests from payers to provide this certificate so it delays the application process. 

Please contact the the CAQH ProView Help Desk for assistance.

Will CAQH implement a re-credentialing application? The disclosure questions are different.

Yes. We are continuously exploring methods for streamlining provider workflows.  

What should we do when we are requested to update other employers' COI that are expired in which we don't have this information to update?

Providers should log in to ProView and ensure their liability insurance is up to date. Once it is updated, they should save and attest.

What's the status on the development of "delegation" so that credentialing specialists can access the accounts of our providers who authorize us to do so?

Our CAQH ProView for Groups simplifies the data maintenance and sharing process between provider groups and health plans by replacing highly manual processes with an intuitive platform designed to improve provider data quality and minimize the burden of data sharing for both sides. Visit our ProView for Groups page for more information.

Is there an easier way to upload information to CAQH without receiving an error? 

Certainly, please contact our Help Desk via the chat feature in the CAQH ProView portal.

We have 450 providers including inpatient and office providers. When information gets granular our credentialing team does not have the ability to gather details. We don't know office hours, languages, telehealth acceptance across our 96 locations. We are trying to keep up with enrolling providers and don't have FTEs to add this level of detail.

Our ProView for Groups services can assist your team in managing the roster of providers. Visit our ProView for Groups page for additional information.

I have a provider that has left our group, and is no longer working. When updating her CAQH profile it insists she has to put in a practice address to attest to the changes. How can we avoid this? We want to show she is no longer with our group for payors to see but she is not working at the moment.

This is a simple fix. Providers should enter an end date for locations where they no longer practice.

Does an FTCA liability certificate for a corporate organization with 30 clinics need a coversheet for an employee of one of those clinics to attach in the CAQH documents?

If a provider is covered by FTCA, please check the FTCA box on the Professional Liability Insurance page. Then upload the document.

 

Questions about DirectAssure 

As regulations are published, does CAQH change the requirement of data fields in CAQH?

Yes, CAQH aims to meet all regulatory requirements.

May we have a checkbox that the provider/managed organization can select "Post to Directory" or "Don't post to Directory"? It is on our HCAS form.

Great suggestion! We will forward the thought to our development team. Currently, CAQH ProView enable providers to indicate their location affiliation. For example, a provider can indicate he/she/they practice at a specified location at least one day per week vs. only reading tests. The health plan will then use the designation to determine if a location should be published in the directory. If you have a ProView profile and have additional questions, contact our help desk via the chat feature located within the portal. If you do not have a ProView profile and would like to learn more about the portal, click here.

I have several duplicate practice location addresses in my profile. How is CAQH informing health plans that the provider already has this address or one very similar (e.g,. Street vs St.) It seems that little things like that are the issue with directories.

CAQH has implemented enhanced address standardization and enhanced practice location matching logic to prohibit providers from entering an address that already exists.  Additionally, in the coming months a new enhancement will be added to CAQH ProView that will notify providers that have active locations with the same physical address.

What can CAQH do to contact these carriers to encourage them to allow Plan staff to take the trainings offered and EXTRACT THE DATA the CAQH data and change their data entry practices to match the data format? If the credentialing Depts start using it instead of Applications, maybe the Directory depts will follow in using the data. Maybe let them know they are paying for the service!

Our Provider Directory Data Improvement Team works closely with health plans to ensure they are using the data to update their directories. Providers can also select, in ProView, the health plans they would like to receive their information.

Will remote practice locations be addressed? Most formats do not allow us to say its a remote location. Some of our locations are once a month, seasonal locations, summer only etc.

In August 2020 we introduced a series of enhancements to CAQH ProView and DirectAssure to capture if a provider delivers telehealth services. The health plan would then take the information and update their provider directory.  


If you have a ProView profile and have additional questions, contact our Help Desk via the chat feature located within the portal. If you do not have a ProView profile and would like to learn more about the portal, click here. For more information on how DirectAssure is assisting health plans collect telehealth-related information, click here.  

What we are finding is Health Plans are adding Insurance plans to our  participation list that are not accurate. I'd think they should request confirmation from the provider prior to adding those to the provider directory. We are spending a lot of time on the back end trying to get that updated. In the meantime patients are getting incorrect information when they search for a provider who accepts their specific plan. How are other practices handling this type of issue?

There are cases where CAQH ProView will present additional practice location information to providers for review.  This stems from health plans having previously collected practice location data for the provider and would like it reviewed for accuracy. The bi-directional data validation approach between ProView and DirectAssure ensures high data accuracy and quality, while saving time and expense for both plans and providers. NOTE: Health plans using the latest generation of DirectAssure can submit practice information for providers to review. 

We have multiple locations. Often a provider doesn't go to the location (labs) but some carriers require that we provide all billing locations and list in directory even though we indicate it is informational only not for directory inclusion. How can we prevent this as some payors will not pay if every location for which a bill is generated is not on their roster.

CAQH ProView enable providers to indicate their location affiliation. For example, a provider can indicate he/she/they practice at a specified location at least one day per week vs. only reading tests. The health plan will then use the designation to determine if a location should be published in the directory.  If you have a ProView profile and have additional questions, contact our help desk via the chat feature located within the portal. If you do not have a ProView profile and would like to learn more about the portal, click here.

Is it standard for Plans to show locations that are just coverage only vs. where active appointments can be made?

CAQH ProView enable providers to indicate their location affiliation. For example, a provider can indicate he/she/they practice at a specified location at least one day per week vs. only reading tests. The health plan will then use the designation to determine if a location should be published in the directory.  If you have a ProView profile and have additional questions, contact our help desk via the chat feature located within the portal.  If you do not have a ProView profile and would like to learn more about the portal, click here.

For a physician who provides telemedicine services and works out a home office and remotes into a facility's EMR, which should be listed as a practice location - the home office, or the facility?

CAQH ProView enable providers to indicate their location affiliation. For example, a provider can indicate he/she/they practice at a specified location at least one day per week vs. only reading tests. The health plan will then use the designation to determine if a location should be published in the directory. If you have a ProView profile and have additional questions, contact our help desk via the chat feature located within the portal. If you do not have a ProView profile and would like to learn more about the portal, click here

How has CAQH solved this 90 day turn around?

The NSA requires providers to update and confirm their practice information quarterly, or every 90-days.


DirectAssure®, a CAQH solution developed in collaboration with CAQH member plans, helps healthcare organizations improve the accuracy of provider directories and meet Federal and State requirements, including the No Surprises Act, 2021. To help health plans remain complaint with the Act, we have updated the solutions provider outreach cadence to mirror the requirement.  We have also updated provider communication highlighting the frequency in outreach and their data responsibilities.  

To prevent delays in capturing information and reduce the risk of receiving inaccurate information, we have simplified the practice location data collection and confirmation process for providers.


For more information on how DirectAssure is assisting over 50 healthcare organizations improve the accuracy of their plan directory and meet the “90-day turnaround rule,” click here.  

We show errors with multiple practices for new providers with previous locations that were never updated.

Contact a member of our team to have this issue resolved.  If you are a health plan representative, please contact your Account Manager for assistance.  If you are a practice manager or provider, please contact the Help Desk via the chat feature in CAQH ProView.

CAQH has the ability to define whether to show an address in the directory or not - why aren't the payers using this?

Great question. Health plans using DirectAssure 2.0 have greater insight into the validity of the providers practice location information.  

DirectAssure 2.0 delivers a confirmation date and the last time the practice location information was edited as an additional layer of assurance. Earlier versions of DirectAssure do not offer this level of granularity.

It could be that some health plans have not navigated to the latest generation of DirectAssure? 

Will the phone outreach ever be updated to match the Credentialing Contact information? I.e.: will payers stop calling offices to confirm directory information? Most offices do not know the accurate directory information.

Great observation, this is currently on our development roadmap to address.    

Is there a plan to have DirectAssure update ProView application data?

Yes, this is currently in practice, the updates are the same however, DirectAssure provides expanded directory information.   If you need further assistance, please contact your Account Manager.

How do you know the providers are telling you what they should be telling you and how do know the person completing the info is the person who should be?

A feature in DirectAssure 2.0 requires providers to confirm the information they have entered into CAQH ProView is accurate.  

Additionally, providers are also required to review, edit and delete practice information health plans may have on file as a function of our “bi-directional data confirmation.”  If the physician is being managed through a delegated relationship, the organization is required to “confirm” that the physicians practice information is correct.

For more information on how DirectAssure is assisting over 50 healthcare organizations improve the accuracy of their plan directory, click here.  

What about community counselors?

Are you inquiring if we can provide directory assistance for community counselors? If so, please contact a member of our Provider Directory Improvement Team for further assistance. 

Why are we asked whether PO Box addresses are practice locations for providers in CAQH?

Actually, this month's (April 2022) system release has removed a providers ability to list a PO Box for a practice location. A notification recently circulated to practice managers regarding this update.  Contact your practice manager for additional details.

Our Tele-radiology providers do not bill and only perform preliminary Reads. Additionally, patients cannot book appointments with our providers as our Radiologists are credentialed to specific sites. Not sure I understand why I am updating CAQH monthly.

CAQH ProView enable providers to indicate their location affiliation. For example, a provider can indicate he/she/they practice at a specified location at least one day per week vs. only reading tests. The health plan will then use the designation to determine if a location should be published in the directory.  If you have a ProView profile and have additional questions, contact our help desk via the chat feature located within the portal.  If you do not have a ProView profile and would like to learn more about the portal, click here.

Will there be one place for payers to verify demographic/directory information? Currently every payer we contract with has a different process which is very time consuming. If they would all use one source it would really be helpful.

Yes, our DirectAssure solution. Through the solution, practitioners update their directory information once and share it with the participating health plans authorized to receive the data. DirectAssure’s multilayered, bi-directional data validation approach ensures high data accuracy and quality, while reducing the need for direct health plan outreach to providers. This saves time and expense for both plans and providers. Feel free to share our contact information, Sales@caqh.org with the payers in your network or, send us the contact information for the payers and we will initiate contact. 

What is best practice for Practitioners who should NOT be listed in directories (Hospitalists, caregivers in Skilled Nursing or Long Term Care facilities, Radiologists etc.)?

CAQH ProView enable providers to indicate their location affiliation. For example, a provider can indicate he/she/they practice at a specified location at least one day per week vs. only reading tests. The health plan will then use the designation to determine if a location should be published in the directory.  If you have a ProView profile and have additional questions, contact our help desk via the chat feature located within the portal.  If you do not have a ProView profile and would like to learn more about the portal, click here.

Some providers perform services in nursing homes on an outpatient basis, they should not be listed in patient directories as they're not available for non-nursing home resident appointments. How can we address this?

CAQH ProView enable providers to indicate their location affiliation. For example, a provider can indicate he/she/they practice at a specified location at least one day per week vs. only reading tests. The health plan will then use the designation to determine if a location should be published in the directory.  If you have a ProView profile and have additional questions, contact our help desk via the chat feature located within the portal.  If you do not have a ProView profile and would like to learn more about the portal, click here.

How can a Practice Manager maintain Directory Data if the provider doesn't share that information? I keep our practice up to date, but I don't think other practices do.

Providers are responsible for the data in their profiles. They should be logging in to update and confirm/attest to the information.

 

Questions about the No Surprises Act 

We have contracts with the different insurance companies that state we have 30 days to notify them if a provider terms. How will that work with the two day notice now or does it pertain at all?

The January 2022 NSA provider directory requirement states health plans have 48 hours upon receipt of the provider information to update their online directories. To assist providers and health plans in meeting the requirement, we have updated the CAQH ProView provider practice location screens to display a date stamp of the last time the information was confirmed. If you have a ProView profile and have additional questions, contact our help desk via the chat feature located within the portal.  If you do not have a ProView profile and would like to learn more about the portal, click here.  

Is the CMS requirement that all providers with the practice be listed in the directory? We have 30 providers but 25 of them are mid-level providers (Physician Assistant and/or Nurse Practitioner).

CAQH ProView enable providers to indicate their location affiliation. For example, a provider can indicate he/she/they practice at a specified location at least one day per week vs. only reading tests. The health plan will then use the designation to determine if a location should be published in the directory. If you have a ProView profile and have additional questions, contact our help desk via the chat feature located within the portal.  If you do not have a ProView profile and would like to learn more about the portal, click here.

There has been conflicting information about whether the NSA directory data validation and update requirements applies to Medicare Advantage and managed Medicaid plans. Do you know whether these plans fall under those requirements?

The No Surprise’s Act’s Continuity of Care, Provider Directory, and Public Disclosure Requirements states, beginning January 1, 2022, these No Surprises Act requirements will apply to items and services provided to most individuals enrolled in private or commercial health coverage, like: 

  • Employment-based group health plans (both self-insured and fully insured) 
  • Individual or group health coverage on or outside the Federal or State-based Exchanges 
  • Federal Employee Health Benefit (FEHB) health plans 
  • Non-federal governmental plans sponsored by state and local government employers
  • Certain church plans within IRS jurisdiction
  •  Student health insurance coverage [as defined at 45 CFR 147.145

For more information visit: The NSA Provider Directory

Can insurance companies at this point kick you out or fine you for having past incorrect addresses on file in the directory when they're contacted to make corrections?

The January 2022 NSA provider directory requirement states health plans must develop a process for data to be verified every 90 days. If plans are unable to verify data must implement a process from removing the providers information from the directory.   Health plans have 48 hours upon receipt of the provider information to update their online directories.  

For more information visit: The NSA Provider Directory

CAQH is now verifying provider practice locations every 90 days. Why aren't health plans using the confirmed addresses to update their directories?

Health plans using DirectAssure 2.0 have greater insight into the validity of the providers practice location information.  

DirectAssure 2.0 delivers a confirmation date and the last time the practice location information was edited as an additional layer of assurance. Earlier versions of DirectAssure do not offer this level of granularity.

For additional insight on how DirectAssure is assisting over 50 healthcare organizations improve the accuracy of their plan directory,” click here. For more information on how CAQH ProView is helping providers meet the January 2022 NSA requirement, click here.  

With the requirements of the No Surprises Act, who is responsible for making sure that provider directory information is accurate and available to insured members, the insurer or the provider?

Health plans and providers are required to improve the accuracy of directories.


Among other measures, the Act requires:

Health Plans:

  • Launch a verification process to update provider directory information quarterly.
  • Implement a process to remove unverified providers quarterly.
  • Execute a process for updating provider directory information within two-days of receipt from the provider.
  • Implement a response protocol that ensures a provider’s network status request is responded to within one business day and communication is maintained for two-years.

Providers: 

  • Ensure the timely submission of provider directory information when:
  • The provider begins a network agreement with a plan with respect to certain coverage.
  • The provider terminates an agreement.
  • Any material changes to the content of provider directory information.

For more information on how DirectAssure can assist health plans in meeting the NSA requirement, click here. For more information on how CAQH ProView can assist providers in meeting the NSA requirements, click here.  

 

Best Practices & Miscellaneous Questions 

What is defined as a "health plan"?

The Cambridge dictionary states, a health plan is a type of insurance that you buy in order to pay for the cost of medical treatment if you are ill or injured.

What can you do when patients are telling us that every doctor they call tells them they are no longer accepting their insurance.  This mostly happens to us with NJ Horizon NJ Health our HMO Medicaid  program?

CAQH ProView requires providers respond to granular questions regarding their practice (e.g.,  if they are accepting new patients, the programs / insurance they accept).  Health plans that are using the latest generation of DirectAssure have access to this information and can use it to update their provider directory.  

Can payers void contracts if the provider's CAQH profile is not current or correct?

The January 2022 NSA provider directory requirement states health plans must develop a process for data to be verified every 90 days. If plans are unable to verify data they must implement a process from removing the providers information from the directory. Health plans have 48 hours upon receipt of the provider information to update their online directories. Contact the health plan's in your network to find out how they will handle the contracts with providers with incorrect profile and practice information.

I thought CAQH was  supposed to be the place for Health Plans to go to get updated information. Is that correct?

While there isn't a formal designation,1.9 providers and hundreds of health plans utilize CAQH ProView and our other provider data solutions.  

How to get insurance companies to access CAQH instead of so many different websites?

You have a few options. Feel free to forward our contact information, Sales@caqh.org or, send us the payer's contact information and we will initiate a conversation

CAQH Program