CAQH

If you've ever gone through the provider credentialing process, you've encountered CAQH. If you're new to independent practice, you're about to. Either way, understanding how CAQH works — and keeping your profile current — is one of the most important things you can do to protect your revenue and speed up payer enrollments.

What Is CAQH ProView?

CAQH ProView is a centralized, online database where healthcare providers store their professional credentials — licenses, DEA registration, malpractice coverage, education history, work history, and more. Over 2.5 million providers have CAQH profiles, and most major insurance companies use it as their primary source for verifying provider information during the credentialing process.

Think of CAQH as your professional resume for the insurance world. Instead of sending the same documents to 10 different payers, you maintain one profile and authorize each payer to access it.

Why CAQH Matters for Credentialing

When you apply to join an insurance panel, the payer needs to verify your credentials. If you have an active, complete, and current CAQH profile, that process is much faster. If you don't — or if your profile is outdated — the payer either can't access your information or has to request it manually, which adds weeks to the process.

An outdated CAQH profile is one of the most common reasons credentialing applications stall. And in a process that already takes 30–90 days for commercial plans and up to 120 days for Medicare, a stall means real money sitting on the table.

The Attestation Requirement: The Clock Is Always Running

Here's the part that catches a lot of providers off guard: CAQH profiles must be re-attested every 120 days. Attestation means you log in, confirm that your information is still accurate, and electronically sign off. If you don't attest within that window, your profile becomes inactive.

An inactive CAQH profile = a blocked credentialing application. Full stop.

We see this happen regularly with providers who set up their CAQH profile once during their initial credentialing and then forget about it. 120 days later, they need to add a new payer — and their profile is inactive. Now you need to re-attest, potentially update outdated documents, and wait for the payer to accept the refreshed profile before your application moves.

What a Complete CAQH Profile Needs

Personal information (name, NPI, contact details)
Professional licenses and their expiration dates
DEA certificate (if applicable)
Board certifications
Medical school and residency/fellowship information
Work history (typically the past 5-10 years)
Malpractice insurance information (carrier, policy number, coverage dates and limits)
Hospital affiliations (if applicable)
Any gaps in practice history explained

Common CAQH Mistakes

Beyond letting the profile lapse, the most common issues we see include: mismatched NPI information, expired malpractice coverage listed, license numbers with typos, and inconsistencies between the CAQH profile and what's on file with the state licensing board. Any of these can trigger a delay or request for additional information.

How Oak & Willow Billing Handles CAQH

We offer CAQH profile setup for new providers and ongoing maintenance to ensure your profile stays active, accurate, and ready for any credentialing application. We track your attestation window and handle the re-attestation process before your profile can lapse.

If your CAQH profile is the problem holding up your credentialing, we can often diagnose and fix it quickly. Contact us at oakwillowbilling.com or call 559-571-2211 to get started.

What Is CAQH and Why Every Provider Needs an Active Profile