Wiki · Credentialing
Definition
An online profile where clinicians enter their credentialing information once and authorize health plans to pull it, instead of filling out a separate application for each payer.
Why it matters
Many plans start credentialing from the CAQH profile. If it is incomplete, unattested or not shared with the plan, the application often waits without anyone telling you.
How it works
- The clinician or group creates a profile and enters licenses, education, work history, malpractice coverage and practice locations.
- Supporting documents are uploaded to the profile.
- The clinician authorizes which plans may view the data.
- The clinician re-attests on a regular cycle so the data stays current.
Common mistakes
- Letting the attestation lapse while an application is in review.
- Uploading an expired license, DEA or malpractice certificate.
- Forgetting to authorize a newly targeted plan.
- Listing practice locations that differ from the group roster sent to plans.
What to check before acting: attestation cycles and plan participation can change. Confirm current requirements in your CAQH account and with each plan.
Related reading
Source
CAQH ProView (official provider portal)
Not affiliated with CAQH. Educational content, not legal advice.