CAQH ProView: How to Set Up and Maintain a Profile Payers Will Actually Use

What CAQH ProView is

CAQH ProView is a free, provider-maintained database of credentialing data. Instead of completing a separate application for every health plan, you complete one profile, attest that it is accurate, and authorize participating plans to pull it. Most major commercial payers use it, and many require it. Medicare and state Medicaid programs do not use CAQH; they have their own enrollment systems.

Registering

Historically a payer initiated your CAQH record and sent you an ID; today most providers can self-register with their NPI. Register under the individual provider’s own name and Type 1 NPI, with an email address the provider or the credentialing coordinator checks. Profiles tied to a staff member who has since left are a recurring source of missed attestation reminders.

Sections payers actually check

• Personal information and identifiers. Legal name exactly as licensed, NPI, SSN, date of birth, and every other name the provider has used (payers verify education under the name on the diploma).
• Professional IDs. State license numbers with expiration dates, DEA and state controlled-substance registrations, Medicare and Medicaid IDs if you have them, and CDS where applicable.
• Education and training. Degree, residency, fellowship, with exact dates. Gaps between training and the first job need an explanation.
• Specialties and board certification. Primary specialty must match the NPI taxonomy you bill under.
• Practice locations. Every location where you see patients, with the correct group name, Type 2 NPI, tax ID, phone and fax, hours, and whether you accept new patients. Payers load these into their directories; a wrong address here becomes a directory error later.
• Hospital affiliations. Admitting privileges or the covering arrangement if you have none.
• Malpractice insurance. Carrier, policy number, limits, effective and expiration dates, plus the uploaded face sheet. This is the document that lapses mid-application most often.
• Work history. Every position for the last several years, month and year, with any gap over thirty days explained in the field provided.
• Disclosure questions. Answer honestly; a “yes” with an explanation is routine, an undisclosed issue found in verification is not.

Documents to upload

State license, DEA certificate, board certificate, malpractice face sheet, CV in month-and-year format, and for some payers a signed and dated attestation or release. Keep the uploaded CV consistent with the work history you typed; reviewers compare them.

Authorizing payers

In the authorization section, either allow all participating plans to access the profile (simplest, and what most providers should do) or select plans individually. If a payer tells you it “cannot access your CAQH,” this setting is the first thing to check.

Attestation: the step that keeps it alive

Attesting confirms the data is current. CAQH asks for re-attestation every 120 days and sends reminders to the email on file. A profile that is not attested shows as expired to payers, and they will hold or close an application rather than call you. Put the attestation date on a calendar that someone owns, and attest again immediately after any change, such as a new location, a renewed license or a new malpractice policy.

Common profile errors we fix

• Practice location listed under the provider’s home address or an old employer.
• Group tax ID entered where the individual’s SSN belongs, or vice versa.
• Malpractice expiration date in the past.
• Primary specialty set to a general category while the NPI taxonomy says subspecialty.
• Work history that ends at the previous job, with the current practice missing.
• Profile attested but no payers authorized.

Maintaining it as a group

For a group, CAQH maintenance is a recurring task across every provider, every four months, forever. Our credentialing service owns it as part of the engagement, with each provider’s attestation date and document expirations tracked in the client portal; organizations that run credentialing in-house use the same expirables tracking in our credentialing software.