The Credentialing Suite allows providers to enter their information and share it with all participating plans at once. This approach reduces provider abrasion and errors and frees practice staff to dedicate more time to patients.
Two million providers enter, update and verify their practice and professional information and select the organizations they wish to provide access. Leveraging proprietary technology, the platform identifies possible errors and prompts providers to review them. This combination of provider engagement and advanced analytics results in more accurate data and efficient business processes.
CAQH streamlines provider profile management for hospitals, health systems and group practices by enabling them to centrally manage profiles, group and location data and share it with participating plans. Available to provider groups and practice managers at no charge, the solution gives administrators confidence that provider data is accurate and complete.
CAQH has partnered with the American Dental Association (ADA) to streamline credentialing for dental offices and plans. Dentists no longer need to complete different applications for credentialing, provider directories and other data needs for each plan. Plans have a trusted, fully automated way of managing their provider networks and directory information.
CAQH collaborated with health plans and provider organizations to develop a primary source verification (PSV) solution that delivers greater accuracy, speed and control to credentialing teams.
The solution validates information entered by providers with live data from licensing boards, medical schools, government registries and other authoritative sources. A specially trained team then validates files to ensure plans have complete and accurate information for credentialing and network decisions.
"Accessing quality data is fast and easy. The credentialing solution has improved our credentialing process tremendously."
Credentialing Specialist Lead
"The COB solution sells itself! Add to that a transparent pricing model and outstanding service and technical support, and you've got a winning combination!"
Team Lead - COB and Medicare Claims
"My account manager had an understanding of our unique needs and was able to translate that insight to support our directory management and credentialing initiatives."
Supervisor, Provider Operations
By continuously monitoring state licensing boards and other federal sources for sanctions and disciplinary actions, the solution identifies providers with multiple state licenses and flags all sanctioned providers on health plan rosters. This streamlines an otherwise manual and painstaking process and reduces the risks to a plan’s members and enhances regulatory compliance.
Average number of days between a licensing board posting an action and CAQH Sanctions Monitoring reporting The Event
CAQH Sanctions Monitoring meets all NCQA factors for a delegation agreement
Number of state licensing boards and federal sources monitored for sanctions
Reduce provider abrasion. Manage networks more efficiently. Maximize internal resouces.