By Bilscure Editorial Team · Published · Last reviewed
Key takeaways
- ProView is a profile that plans read. It is not the plan's own application, and not every plan uses it.
- Providers must re-attest the profile on a regular cycle, and a lapse can freeze enrollment.
- Credentialing confirms qualifications. Contracting sets rates. They are two separate steps.
- Start before the provider's first day, because weeks without enrollment are weeks without payment.
What the term means
CAQH credentialing is the work of building and maintaining a provider's profile in CAQH ProView so health plans can check their qualifications. CAQH is a nonprofit alliance of health plans and related organizations. Its ProView system stores one profile for each provider, and the provider chooses which plans may view it.
The point is that a provider enters most of the information once instead of completing a fresh form for every plan.
What a complete profile holds
Expect to supply:
- Personal details and every practice location
- Education, training and board certification
- Active state licenses and DEA registration where relevant
- Work history, with any gaps explained
- Malpractice coverage details
- Hospital affiliations
- The provider's NPI, which can be found or requested through NPPES
- Scanned copies of licenses and certificates
Keep the documents up to date. An expired license on file is a common reason for a plan to put an application on hold.
Re-attestation
Providers must confirm from time to time that their profile is accurate. CAQH calls this re-attestation and asks for it every 120 days. If it is missed, a plan may stop relying on the profile, which can pause a pending application or put current enrollment at risk.
Put the due date on a shared calendar and not in one person's head.
How the pieces connect
- NPI is the provider's national identifier. Everything else points to it.
- CAQH ProView holds the data many commercial plans read.
- PECOS is the Provider Enrollment, Chain and Ownership System that Medicare uses.
- Plan applications are the individual forms or portals. Some require CAQH. Others use their own.
Credentialing is not contracting. Credentialing verifies the provider. Contracting sets what the plan will pay. A provider normally needs both before in-network claims are paid at the agreed rates.
Common ways it goes wrong
- Applying after the provider has already started seeing patients
- Unexplained gaps in work history
- Expired documents sitting in the profile
- A missed re-attestation
- Nobody responsible for chasing each plan
Plans set their own timelines, so the practical advice is to begin early and follow up on a schedule.
Doing it yourself versus handing it off
For one provider and one or two plans, with time to spare, doing it in-house is reasonable. When you are adding several providers, joining many plans or already waiting on approvals, the follow-up alone justifies outside help. Bilscure credentialing is from $100 per payer plan.
When outside help does not apply
A provider who is not yet licensed in the state cannot start applications. Payer rate negotiation is a different service from credentialing.
What our team does
We create and attest the CAQH profile, complete each plan's application, chase until the plan responds and track renewals afterward. See credentialing services or request the free billing audit.
This article is general information, not legal or compliance advice. Payer rules and regulations change, so confirm current requirements with the payer or the governing agency.