Skip to content
Search
Get in Touch
Search

Resources

CAQH thought leadership, best practices, case studies and other resources help healthcare leaders gain a deeper understanding of business challenges today and see the opportunities for the future.

Case Studies Solutions FAQs

Solutions Fact Sheets

Latest Reports & Issue Briefs

CAQH_CORE_Price-Transparency-Whitepaper_Final1024_1-1

Establishing The Building Blocks For Price Transparency:

Industry Guidance on Provider to Payer Approaches for Good Faith Estimate Exchanges

Updated_VBP_Issue_Brief_Cover2-1

Unifying Value:

Industry Opportunities to Streamline Value-based Payment Data Exchange

CORE_Claims_Issue_Brief_Cover-1

Opportunities to Enhance the Utility of Electronic Health Care Claims

Opportunities for operating rules to support claim submission, acknowledgement, and error reporting; VBP and SDOH; and telehealth POS assignment.

Resources to Optimize Operations

Solutions FAQs

Click here to see frequently asked questions for our provider data, member data and interoperability solutions.

CAQ-Image-Web-15

Provider Data and Credentialing

CAQ-Image-Web-21

Coordination of Benefits

Provider Data and Credentialing

What is the Provider Data Portal?

The CAQH Provider Data Portal is an automated platform where physicians, dentists and other healthcare practitioners enter, update and verify professional and practice information and securely share it with the organizations that they authorize. 

How does the Provider Data Portal help me?

The Provider Data Portal allows you to store all your professional information including documents such as your license, training certificates, liability insurance and more. It also helps you ensure the information is correct by identifying errors and then sends you reminders when it’s time to confirm or update your information. 

Do all states accept data from CAQH?

The CAQH Provider Data Portal enables providers to generate a completed credentialing application that is accepted in all 50 states, even those with unique requirements. See the map.

The system is constantly being updated to address new state and federal regulatory requirements. 

The CAQH Provider Data Portal complies with data collection requirements for NCQA, URAC, and JCAHO and data is secure using HITRUST CSF best-in-class data protection standards.

How do health plans and payers use my data?

Public and commercial payers across the country access the information to address a variety of provider network uses, including credentialing, network and referral management, provider directories, health equity and more.

How widely used is the CAQH Provider Data Portal?

Currently, 2.5 million healthcare providers, >100K dentists and 1,000 health plans, hospitals and other healthcare organizations participate with CAQH solutions to simplify credentialing. This prevents you from having to enter the same information multiple times to accommodate payers on different platforms and credentialing cycles. 

Are all physicians and other healthcare professionals required to use the Provider Data Portal?

No, participation in the CAQH Provider Data Portal is voluntary. However, more than 1,000 health plans and other healthcare organizations have requested that their network providers use the Provider Data Portal for credentialing. 

Does it cost anything to use the Provider Data Portal?

No, health care providers may use the Provider Data Portal to enter, maintain and share their professional and practice information free of charge. Health plans and other healthcare organizations pay to use CAQH Provider Data for credentialing and other important administrative functions.  

How do I start using the CAQH Provider Data Portal?

You can choose to use the CAQH Provider Data Portal at any time. You may also receive a welcome email with a link to register if a health plan you are affiliated with asks CAQH to invite you to use the portal. 

  1. Register or update your profile at visit https://proview.caqh.org.
  2. Complete your profile and upload your documents.
  3. Attest that all information is truthful and complete.
  4. Authorize plans or other organizations to access your profile.

Who can I contact for help or if I have any questions about CAQH Provider Data?

Contact the Help Desk using our Chat feature in the portal or call us toll-free at 888-599-1771. Please have your CAQH Provider ID available.

  • Live chat support is available through the portal Monday – Friday, 8:30 AM – 6:30 PM (EST). Automated chat support is available 24/7.
  • Phone support is available Monday – Friday 8:00 AM – 8:00 PM (EST). 

Is there training available if I need help?

Yes, CAQH University is an online, easy way to learn more about CAQH provider data solutions. This training is available at no additional charge and can be accessed through the Provider Data Portal.

Coordination of Benefits

What is CAQH Coordination of Benefits?

Coordination of Benefits (COB) has been a persistent challenge for the healthcare industry, resulting in delayed and inaccurate payments, appeals and significant recovery activities and expenses. The COB Solution is a forward-thinking registry of coverage information that enables health plans and providers to correctly identify which members have benefits that should be coordinated. This way, corresponding claims are processed correctly, the first time.

How does CAQH Coordination of Benefits work?

Participating health plans supply information to the CAQH COB registry each week, where it is compared with data from other health plans to identify patients with coverage from more than one plan. National Association of Insurance Commissioners' (NAIC) rules are applied to determine the correct order of primacy for benefit coverage. Relevant information is then shared with each participating health plan that insure the member and is also accessible to providers so they can route claims correctly. 

Why use CAQH COB?

CAQH Coordination of Benefits streamlines benefit coordination for health plans, providers and patients. Timely and accurate COB information produced by CAQH COB increases efficiency and helps to reduce:

  • Administrative costs
  • Inaccurate payments
  • Member and provider call volumes
  • Claim rework
  • Dependency on overpayment and recovery vendors

Who should use CAQH COB?

CAQH COB can be used by many types of health organizations:

  • Health Plans
  • State Sponsored Programs
  • Clearinghouses

Who can I contact for help or if I have any questions about CAQH COB?

To learn more about reducing the challenges and costs associated with coordination of benefits, contact your CAQH representative or email: COB@caqh.org.

Case Studies

Read how our data solutions have helped save costs and reduce administrative burdens across the healthcare industry.

View All Case Studies

CAN'T FIND WHAT YOU NEED?

Visit our CAQH University page for more learning tips, resources and information on our chat and call center support services.

CAQH University