CAQH Updates: Ace New Features and Speed Credentialing Process

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CAQH Updates: Ace New Features and Speed Credentialing Process

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CAQH credentialing process

QUESTION: I credential our providers via the online CAQH portal and I am confused by some of the recent updates. Specifically, the taxonomy code set change and the new NUCC grouping. Does CAQH now follow the NUCC code set? What other changes are new?  CAQH credentialing process.

Parsippany, NJ subscriber

ANSWER: The CAQH updates bring a lot of new features. But like all new software you’ve got to get used to the changes before you reap the benefits of a faster credentialing process. You are right that as part of the recent changes the Personal Information page was redesigned and included adding the National Uniform Claim Committee (NUCC) Grouping. This new addition aligns CAQH with the NUCC Provider Taxonomy code set, which is an accepted industry standard. Going forward, the NUCC Grouping you select will customize your CAQH application view.

CAQH Credentialing Process Updates with NUCC Grouping

While the addition of the NUCC Grouping will eventually streamline and standardize the application process, new users will need to do some work.

  • New applicants: Anyone using the system for the first time will have to enter their NUCC Grouping. You can’t leave this field blank or it WILL be flagged on the Contact Errors page to fix. It’s important because your NUCC grouping selection—along with the Provider Type, Practice Setting, and Practice State responses—affect the rest of the profile questions in your application.
  • Existing applicants: The NUCC Grouping data should map automatically based on an existing specialty associated with the profile. If you don’t have a specialty entered it will map based on Provider Type.

Determine Your NUCC Grouping

To find your specialty and the corresponding NUCC Grouping, you can reference the Healthcare Provider Taxonomy guide.

The following specialties will soon be inactive, so you will need to pick a new specialty, provider type, and Board if applicable:

  • Laboratories, Clinical Medical Laboratory
  • Supplier
  • Other, Not Listed

Other CAQH Updates

You can further speed up your credentialing process by getting used to some of the other newly introduced elements. CAQH has implemented a number of other updates within the last year based on user and provider feedback, some of which include:

Self-lookup tool. The Provider Portal Home Login screen will have an option for a user to self-look up a CAQH Provider ID. On the redirected Provider Self Registration page you’ll need to enter personal information to receive your account information or you will need to create a new registration.

Page redesigns. The Personal Information page and Education Pages are being redesigned to reduce time and boost the user experience. Enhancements include:

  • Optional, irrelevant fields will be hidden or made easier to skip
  • On-page explanations for each field will be added
  • Fields will pre-populated with already entered information

TIN added to provider practice locations. A TIN will be added to the definition of a unique address to accommodate groups with multiple practices that operate from the same location. You will be able to input information for a practice location accurately, without compromising your data quality.

Display Full Disclosure Explanations. Instead of being cut off due to space limits as in previous versions, your disclosure explanations will be applied to supplemental forms which will then be added to several state replicas. This way participating organizations and providers can review your full disclosure explanation.

Federal Torts Claim Act Coverage Option. If you carry Federal Torts Claim Act coverage for Professional Liability Insurance you will be able to select the option that you do have coverage and then upload your documentation. You will also be able to associate this coverage or other traditional policy to a specific practice location.
This is just a short CAQH updates quick sheet. CAQH credentialing process.

There’s more step-by-step advice from credentialing expert Yesenia Servin, CPMSM, PESC in her online training “Credentialing: Master New CAQH 2020 Changes and Get Paid.” She’ll walk you through additional practical tips on how to incorporate the CAQH updates in your process, as well as guidance on best strategies for streamlining your CAQH account management.

Source: CAQH ProView® Provider User Guide

Online Training For Physician Credentialing

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Credentialing: Master New CAQH 2020 Changes and Get Paid
PECOS: Master CMS Surrogacy Enrollment Requirements
Credentialing 101 for Your Practice

Meet Your Writer

Yesenia Servin

Nationally Certified Credentialing Specialist

Yesenia Servin is a nationally certified credentialing specialist, with over 20 years of experience in healthcare credentialing, contracting and payer enrollment. Her background includes working with various healthcare organizations, Durable Medical Equipment (DME), Managed Care Organizations (MCO), Community Mental Health Centers (CMHC), and Academic Health Systems. In addition to her role with Loyola University Medical Center, Yesenia has built her professional consultation business to serve healthcare professionals of all specialties. As a well-rounded credentialing specialist, her expertise extends through managing both provider credentialing and payer credentialing and enrollment. Yesenia enjoys spending time with her family and jumping into the mini-van with them for a road-trip.