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  4. Credentialing Suite

Data directly from the source.

The CAQH Credentialing Suite enhances data quality, network management and regulatory compliance by drawing on information directly from the source — the providers themselves. 

Simplify Your Credentialing Workflow

Credentialing can be costly and complicated for both providers and payers. For more than 20 years, CAQH has worked with plans, practices, groups and other organizations to make collecting, verifying and exchanging information needed for credentialing efficient and secure.

Fact Sheet for Plans   Fact Sheet for Providers

Drive Provider Engagement and Data Quality

Streamlined Credentialing
Providers and group administrators enter data once and it is shared with all plans they designate.
Enhanced Primary Source Verification
Manual processes are automated, simplified and improved.
Continuous Sanctions Monitoring
Sanctioned providers are flagged daily, improving network management and regulatory compliance.

Trusted by Providers Nationwide

2.4M
Participating providers across 757 specialties
1.4M
Providers verified their data within the past 120 days
73%
Of all US physicians participating
101K
Participating dentists

The Credentialing Suite

For Providers
Two million providers enter, update and verify their information and select the organizations they wish to provide access, resulting in more accurate data and efficient business processes.
For Groups
CAQH streamlines workflows by enabling groups to centrally manage profiles and share them with participating plans.
For Dental Offices
CAQH has partnered with the American Dental Association to streamline credentialing for dental plans and reduce administrative burdens for practices.

Effective Credentialing Solutions. Impactful Results.

Blue Cross and Blue Shield of Alabama:

Proven tactics for improving your provider credentialing process.

Ballad Health:

Standardization cuts time spent preparing rosters in half.

Credentialing as easy as 1-2-3

Simplify credentialing with a powerful, integrated platform.

Primary Source Verification

The CAQH Primary Source Verification solution validates credentialing information with live data from licensing boards, medical schools, government registries and other authoritative sources, delivering greater accuracy, speed and control to plans.

 

"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
Previous Next s

Sanctions Monitoring

By continuously checking for disciplinary actions and flagging issues daily on health plan rosters daily, CAQH Sanctions Monitoring streamlines a painstaking process and enhances regulatory compliance.

4.5
days
average time for plans to be notified of a disciplinary action.
NCQA
compliant
sanctions monitoring meets all NCQA factors for delegation agreements.
500
sources
monitored for sanctions.

Ready to learn more?

Reduce provider abrasion. Manage networks more efficiently. Maximize internal resources.
 
Credentialing Suite
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