Your patients pay for their health insurance and want to use it. This means that if you want to treat them, you need to be enrolled in their health insurance plan. Participating in insurance networks almost certainly guarantees you will be required to utilize the Council for Affordable Quality Healthcare (CAQH) ProView Portal, and it is imperative you use it correctly if you want your provider to be paid. CAQH ProView Portal.
So, what is the CAQH ProView Portal?
CAQH is a non-profit organization that offers a variety of web-based solutions to help make connecting with health plans, vendors, government entities, etc. easier and faster for you. The CAQH ProView is their centralized online service that standardizes the collection and sharing of provider information. So instead of having to send the same paperwork over and over again to each payer you want to enroll with, you do it once.
The challenge is that utilizing the CAQH ProView Portal isn’t always easy. While it beats pen and paper, you are still required to input a ton of information and the process can get confusing. One missing field on your CAQH application will delay your enrollment approval and the associated reimbursements, which is the reason you’re doing this in the first place—to save time and get paid quicker!
Why Bother with CAQH ProView?
There are times when technology feels like more trouble than it’s worth. The truth is, you don’t HAVE to use CAQH ProView. But without it, you will be responsible for credentialing and certifying individually with every payor, vendor, hospital, etc. Think about all of the applications you will have to fill out and all of the information you’ll have to submit over and over again.
Here are some key benefits to you and your practice to utilizing the CAQH ProView portal:
- Eliminate Redundancies. Credentialing is a lengthy process that you have to go through for every payor, hospital, large provider group, and health system with which you intend to participate. Using ProView simplifies the process. You only input your information once, and then submit one credentialing application where respective parties can access it.
- Easy Access. Although you must complete the entire CAQH profile, you don’t need to do it all in one sitting. You can save it at any point and log in at another time to finish. And because it’s electronic, you don’t need to mail or fax anything—just upload your supporting documents right into the portal.
- Current Information. Whenever you need to, you can update the information you’ve put into the portal. In fact, CAQH will send you attestation notices and ask you to check that the information is still correct. So, a simple change of address or phone number can be input once and anyone who is affiliated with you through the portal will have your updated information.
- Free for Providers. While insurance companies and healthcare organizations pay to have access to your information, as a provider (or practice manager) you don’t pay anything to utilize the service.
Who Should Have Access to Your CAQH account?
Security is a top concern, and CAQH works to protect the privacy of individually identifiable information. With this in mind, it’s important that you do the same. This means that only certain individuals should be responsible for inputting specific information.
- Physician. A physician SHOULD complete the provider profile which entails all of the provider’s personal information. If you’re new to the system or just need some help, CAQH has a Physician User Guide PDF to reference. However, we know this probably will NOT happen. It will be up to the practice manager or the physician’s administrative assistant to input the provider’s information.
- Practice Manager. A practice manager can utilize the Practice Manager Module within ProView to enter information that is common for multiple providers at a healthcare practice—such as the clinic name, address, and phone number—eliminating the need for the information to be input multiple times. There is a user guide PDF for practice managers as well, which outlines how practice managers can work together with providers to complete the CAQH application.
Note: As a practice manager you are not permitted to attest that the information is correct on behalf of the provider within the Practice Manager Module. A practice manager can input information and export it to a provider’s data profile, but then the provider should actually attest in the individual provider account.
How Often Should You Update Your Profile?
Filling out your initial CAQH ProView profile will take a few hours; after that you can take a deep breath and relax, for a short time anyway. However, it is important that you maintain your profile. Any time you have a change to your status, whether a simple phone number or change of address; you should definitely log into the portal and update your information. You are also required to review your data and attest that it is accurate once every four months, but you should receive automatic reminders to do that via email.
Managing Your Account with 2021 CAQH Changes?
CAQH ProView is definitely a time saver that will reduce redundant paperwork and administrative tasks. But it takes some time to understand, and one simple missed field or typo will delay your reimbursements. There are also a lot of changes to CAQH ProView in 2021—some have already happened, and some are coming down the pike. Although mastering the CAQH ProView Portal can be a challenging process, you don’t have to struggle. Credentialing expert Yesenia Servin, CPMSM, PESC can answer all of your CAQH ProView Portal questions at her upcoming 60-minute online training, Cut Through CAQH Credentialing Portal Confusion to Get Paid Faster, on Thursday, April 15th at 1pm ET.
Don’t wait another minute—you need to know how to accurately and confidently create and update your CAQH ProView portal so you can get paid for all of your medical services. Sign up now!
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