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CAQH Provider Data Portal – Help Page

Please visit CAQH.org for Provider Data Portal FAQs and for additional information about our solutions.
Participating Organization Help:

Question Answer
1. What types of solutions does CAQH provide? CAQH provides technology-driven solutions to reduce costs, streamline administration, and make healthcare work better for payers, providers and members.
For more information, please visit www.CAQH.org.
2. What is the CAQH Provider Data Portal? The CAQH Provider Data portal collects, verifies and manages the industry’s most extensive, up-to-date and trusted source of healthcare data to enable plans, providers and other organizations streamline operations, reduce costs and transform business processes. CAQH automates provider data collection by using a standardized electronic application that meets the needs of nearly every health plan, hospital and other healthcare organizations.

The Credentialing Suite enables physicians and other healthcare professionals in all 50 states and the District of Columbia to enter information free-of-charge into a secure, centralized database. Authorized plans and healthcare organizations can access this data to assist with credentialing and other business processes.
3. What business challenges does the CAQH Provider Data Portal help solve? By streamlining data collection, the CAQH Provider Data Portal reduces redundant processes and saves millions of dollars in annual administrative costs. This benefits the 2.5 million healthcare providers and 1,000 health plans, hospitals and other healthcare organizations that partner with CAQH.
4. What business processes does the CAQH Credentialing Suite help simplify? The CAQH Credentialing Suite is the industry standard for collecting provider data and practice information used in credentialing. This data can also be used for network directories, quality assurance, coordination of benefits, member services, emergency response and more.
5. Why is simplifying credentialing an important issue? The paperwork associated with credentialing is a time-consuming task facing physicians, other healthcare providers, practice managers and healthcare organizations. A typical healthcare provider contracts with 10 - 20 payer organizations, each requiring the provider to complete an extensive credentialing application.

CAQH simplifies this process by enabling providers to submit one standard credentialing application to satisfy the credentialing requirements of all participating health plans and other organizations. This significantly reduces the administrative time and effort of managing the credentialing process.
6. Which departments within an organization benefit from CAQH Provider Data? The data rich provider data CAQH collects can be used to support credentialing, quality assurance, claims, member services departments and others. This Provider Data Portal streamlines administration, enhances accuracy and regulatory compliance and enables plans to continuously credential their networks.
7. How does CAQH meet the requirements for NCQA, JCAHO, URAC and others? CAQH developed the Credentialing Suite through a collaborative effort to help improve the credentialing process for all stakeholders. The Credentialing Suite was designed with input from NCQA, JCAHO, URAC as well as many health plans and a work group of healthcare providers. Working together, CAQH and participating organizations across the industry are making healthcare more simple, secure and efficient.
8. Can the CAQH Provider Data Portal be used in states where there is a state-mandated credentialing application? Yes. In states where legislation mandates the use of a standard credentialing application form, the data collected in the CAQH Provider Data Portal includes data fields required by the state.
9. Is primary source verification included in the CAQH Credentialing Suite? Yes, primary source verification is part of the Credentialing Suite which can be purchased for an additional cost. CAQH Primary Source Verification is completed in the credentialing application, helping health plans quickly and accurately determine whether a provider meets that organization's standards for participation.

If you would like to learn more about CAQH Primary Source Verification, please contact sales@CAQH.org to speak with a sales representative.
10. If my organization uses a credentials verification organization (CVO), will they be able to access the Provider Data Portal? An administrative user for your organization can grant access to your data and provider profiles to an external CVO or other organization.
11. Can my organization request additional data fields for the CAQH Provider Data Portal? The CAQH Provider Data Portal simplifies administrative processes with a streamlined and robust data set. Participating organizations should not need additional information beyond what is already included in the credentialing application. Health plans may need to clarify or confirm certain responses with individual physicians and other providers on a case-by-case basis.
12. How much does it cost to access the CAQH Provider Data Portal? There is no cost for providers to use the CAQH Provider Data Portal if a health plan or other organization has requested that your organization participate. For more information contact CAQH at 202-517-0400 or email sales@CAQH.org.
13. How do I contact the CAQH Solutions Center? Please contact the CAQH Solutions Center via live chat or by calling 888-600-9802. Live chat can be accessed by logging in to your account and clicking the chat icon at the bottom right hand side of the pages.
Live Chat hours are:
  • Monday – Friday: 8 AM – 5 PM (EST)
Phone hours are:
  • Monday – Friday: 8 AM – 5 PM (EST)
14. How does CAQH ensure the confidentiality and security of my organization’s provider data? The confidentiality and security of provider data and the privacy of system users are critical priorities for CAQH which is why the Provider Data Portal is HITrust CSF certified, ensuring it meets regulations for protecting and securing private healthcare information.

The CAQH database is housed in a secure Tier 3 data center. Access is limited to authorized support staff and controlled by multiple levels of physical security. All network traffic to and from the center is routed through redundant firewalls for complete security to the database and online systems. Secure Internet access to application screens, use of passwords, electronic signatures/certificates, and powerful Secure Socket Layer (SSL) encryption are used to ensure only authenticated use of the system. Only password/PIN-authenticated users have access to their restricted data over connections that automatically encode all information exchanges. Virus detection mechanisms are used and routine encrypted back-ups protect all system data and are secured in an off-site storage facility.