Credentialing•5 min read
CAQH ProView: What Practices Get Wrong.
Most commercial payers pull credentialing data straight from CAQH. If the profile is incomplete, unattested or contradicts the application, the file stalls — and nobody tells you. This guide covers what to maintain and how often.
Key takeaways
- CAQH is the source of truth for most commercial credentialing.
- Attestation must be refreshed on schedule, not only when applying.
- Documents expire quietly — licenses, DEA, malpractice, board certificates.
- Payers must be authorized to access the profile.
What belongs in the profile
A profile is complete only when every element is current and internally consistent.
- Personal and professional identifiers, including NPI
- Education, training and complete work history with explained gaps
- State licenses, DEA registration and board certification
- Malpractice insurance certificate with current coverage dates
- Practice locations, hours, group affiliations and tax IDs
- Disclosure questions answered accurately and consistently
The four failure modes
Almost every stalled credentialing file traces back to one of these.
- Expired attestation — the profile stops being usable to payers
- Expired uploaded documents that were never replaced
- Payer authorization not granted, so the plan cannot pull the data
- Profile data that contradicts the payer application, triggering manual review
A maintenance routine that works
Treat CAQH as a recurring operational task with an owner, not a one-time onboarding step.
- Calendar the attestation cycle for every provider
- Track document expiry dates centrally and replace before they lapse
- Re-check payer authorizations whenever you add a plan
- Reconcile CAQH against the practice's own credentialing file quarterly
Frequently asked questions
CAQH requires periodic re-attestation. Practices should treat it as a recurring calendar item per provider rather than something handled only when a new payer application is submitted.
Related
Talk it through with a specialist.
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