Comply with 2021 CAQH ProView Changes & Avoid Payment Delays

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Comply with 2021 CAQH ProView Changes & Avoid Payment Delays

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CAQH Profile

Keeping your provider credentialing up to date is critical to your practice’s financial success, and your CAQH profile is a big piece to that puzzle.

2021 is bringing significant updates to CAQH ProView that you can’t afford to miss. It’s imperative that you get a handle on these changes now otherwise you’ll feel it in reimbursement delays later.

There are a multitude of CAQH updates coming in 2021. Some of these were already implemented in January and others will be released in the coming months.

2021 ProView Updates to Maintain Your CAQH Profile

CAQH ProView updates were implemented with the intent to ease the credentialing process, but changes to the user interface can often have the opposite effect. The problem is that keeping your CAQH profile updated is key to reimbursements, so you really can’t afford any confusion or delay. Here’s what you must know about the 2021 ProView changes to make your CAQH profile update process go more smoothly and significantly speed up your provider enrollments

Updated Home Page

After you log in the newly updated CAQH ProView Home page might throw you for a loop. But the new design gives you insight into your profile status, showing you at-a-glance what you still need to complete.

New enhancements in the Profile Data section include:

  • your completeness percentage
  • how many questions are remaining
  • the date of your last update

Look to the top and left navigation menus to visualize your completion status. A green progress bar with a check mark will indicate completeness, a yellow bar will indicates some information has been submitted, and a blank progress bar means you have missing data or a validation error.

Document dilemmas: If your profile has missing or expired documents this will also display in the Documents section on the homepage, expanding the Documents section by default if there is anything you need to fix.

Other new Home Page features include:

  • Links to Directory Data, Data Summary, and State Application
  • Broadcast Message pop-ups will communicate system updates or report system wide issues when you log in
  • Dynamically expanding sections where input is needed or collapsed sections to indicate completeness

Indicate Just One Primary Practice Locations

Keeping your practice locations up-to-date in your CAQH profile is important because it designates your primary location and facility. There are a number of new additions to the Practice location section in ProView geared toward making sure you indicate your one primary location:

  • You will see a message for any record with an error along with an error icon on the specific tab that needs attention.
  • If you indicate more than one location as your primary practice, you will receive an error on the summary page and within the record.
  • If you have multiple practice locations but haven’t selected a primary location, you will be prompted on the Correct Errors page to indicate a primary practice.

Out-of-state authorization: IF you change states or add a practice from a different state whose authorization form is different you will be prompted to upload it into your profile.

Employment Information and Profession Training Create Gap Record

Gaps between education and employment in your provider records are red flags. CAQH ProView will now create a gap record on the work history page which you can go into and edit to provide an explanation. Your provider records must include both a start and end date, be within the last ten years, and fall within these Education and Professional Training types:

  • Internship
  • Residency
  • Fellowship (start date now required)
  • Preceptorship
  • Other Trainings (start date now required)
  • Undergraduate (start date now required)
  • Fifth Pathway
  • Professional School

State-Specific Changes

There are a few state-specific modifications that you should be aware of if you practice in North Carolina, Illinois or Arizona.

  • North Carolina. There are two questions from the Disclosure section that were moved to the Education/Training/Affiliation section, and the display functions have been improved to accommodate long responses.
  • Illinois. If you answer Yes to a disclosure question, all responses will be captured and legible in the replica, and display functions have been improved to accommodate long responses.
  • Arizona: If you practice in AZ you aren’t required to enter a CDS record. If you do try to add one you will be prompted that it isn’t necessary. If you already have one entered, the next time you log in you will be prompted to delete it.

These are just a few of the CAQH ProView changes, but there is much more to know. The bottom line is you must comply with all of the CAQH updates to keep your payments coming in on time, and you also need to have an exact process in place to maintain your CAQH accounts and ensure accuracy.

The good news is you can get help from nationally certified credentialing specialist, Yesenia Servin, CPMSM, PESC. In her 60-minute training, Yesenia will go over all the 2021 ProView updates and show you how to successfully complete and update your provider CAQH profile.  By attending this training, your credentialing process will go more smoothly, be more accurate, and your providers’ reimbursement will keep flowing.

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.