Guide to Setting Up Your CAQH ProView Profile

This guide will help you efficiently complete your CAQH ProView profile.

The CAQH ProView application is primarily at the individual provider level, not the practice level. Each healthcare provider (MD, NP, PA, etc.) must complete their own profile for credentialing with payers.

The practice itself will apply separately with insurance payers for group contracts.

What is CAQH ProView and Why Was It Created?

CAQH ProView is an online credentialing database used by healthcare providers to streamline the credentialing and enrollment process with insurance payers. It serves as a central repository for provider information, allowing insurance companies, hospitals, and healthcare organizations to access up-to-date credentials and professional details.

CAQH (Council for Affordable Quality Healthcare) was created to reduce administrative burdens in healthcare by eliminating redundant paperwork and streamlining credentialing processes. Before CAQH, providers had to submit credentialing applications separately to each insurance company, leading to inefficiencies, delays, and increased costs. By using CAQH ProView, providers complete one standardized credentialing profile that can be shared with multiple payers, improving efficiency and reducing the time needed for insurance approvals.

Here are the key links you will need to access to complete their CAQH ProView profile:

CAQH ProView Registration & Login

• CAQH ProView Portal: https://proview.caqh.org
  • Use this link to register, log in, and complete the credentialing profile.

CAQH Support & Resources

• CAQH ProView Help Center: https://www.caqh.org/solutions/caqh-proview
  • Find FAQs, user guides, and video tutorials on completing your CAQH profile.
• CAQH Provider Resources: https://www.caqh.org/providers
  • Access additional CAQH services, including EnrollHub for EFT payments and DirectAssure for directory updates.

Other Relevant Credentialing Links

• NPPES NPI Registry (for NPI Numbers): https://nppes.cms.hhs.gov
• IRS Form W-9 (for Taxpayer Identification Number): https://www.irs.gov/pub/irs-pdf/fw9.pdf
  • You will need to upload this form as part of your profile.

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Step 1: Gather Required Information & Documents

Before starting your CAQH ProView application, collect the following information and documents to streamline the process.

Personal & Demographic Information

• Full legal name
• Date of birth
• Gender
• Social Security Number (SSN)
• Home address & mailing address
• Personal contact information (phone & email)
• Languages spoken

Education & Training

• Medical/Professional school name, degree, and graduation date
• Graduate school details (if applicable)
• Internship, residency, and fellowship details (institution name, specialty, dates of attendance)
• Teaching appointments (if applicable)

Licensure & Certifications

• State medical/nursing license(s) (license number, state, expiration date)
• DEA registration certificate (number and expiration date)
• Controlled Dangerous Substances (CDS) certificate (if applicable)
• Board certifications (specialty, certifying board, expiration date)
• ACLS/BLS or other specialty certifications (if applicable)

Practice Information

• Practice name and type
• Practice address(es)
• Office contact details (phone, fax, email)
• Office hours and services provided
• Billing contact & credentialing contact information
• Tax Identification Number (TIN) and Employer Identification Number (EIN)
• National Provider Identifier (NPI)
• Medicaid/Medicare provider numbers (if applicable)
• Partners and covering colleagues (if applicable)

Hospital Affiliations

• Hospital name and address
• Privilege status (active, courtesy, consulting, etc.)
• Start date at each hospital
• Contact details for hospital affiliations

Professional Liability Insurance

• Malpractice insurance carrier name
• Policy number & coverage limits
• Coverage start and expiration date
• Upload a copy of the malpractice insurance certificate

Work History

• Employment history for the past five years
• Practice/Employer name, address, and dates of employment
• Explanation of gaps in work history longer than six months

Professional References

• At least three professional references (colleagues in the same specialty)
• Names, titles, specialties, phone numbers, and email addresses

Disclosure & Attestations

• History of disciplinary actions, malpractice claims, or legal issues
• Criminal background disclosure
• License sanctions, suspensions, or terminations
• Medicare/Medicaid sanctions (if applicable)
• Explanation of any reported issues

Additional Required Documents

• IRS Form W-9
• State medical/nursing license(s)
• DEA registration certificate
• Controlled and Dangerous Substances (CDS) certificate (if applicable)
• Board certification(s)
• Malpractice insurance certificate
• Current CV/resume
• Hospital privilege letters (if applicable)
• Medical/professional school diploma
• Residency/Fellowship completion certificate
• Driver’s license or passport

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Step 2: Complete Your CAQH ProView Profile

1. Register for a CAQH ProView Account

• Visit https://proview.caqh.org and click "Register" or "register here".
• Register as a new provider.
• Set up a username, password, and security questions.

2. Enter Personal Information

• Fill in your name, date of birth, gender, SSN, and contact details.
• Add your home and preferred mailing address.
• Specify language(s) spoken.

3. Provide Education & Training Details

• Enter medical/professional school, residency, and fellowship details.
• Add internships and teaching appointments (if applicable).

4. Input Licensure & Certifications

• Enter state medical/nursing licenses (license number, state, expiration date).
• Provide DEA and CDS registrations.
• Add board certifications and specialty certifications.

5. Enter Practice Information

• Provide practice name, type, and location(s).
• Enter billing and credentialing contact information.
• List services, office hours, and partner providers.
• Input TIN, EIN, NPI, and payer details.

6. Add Hospital Affiliations

• Provide hospital names, addresses, and privilege details.
• Include start dates and contact details.

7. Upload Malpractice Insurance Details

• Provide carrier name, policy number, coverage limits, and dates.
• Upload malpractice insurance certificate.

8. Complete Work History

• Enter employment history for the past five years.
• Explain any gaps longer than six months.

9. Provide Professional References

• List at least three professional references with contact details.

10. Answer Disclosure & Attestation Questions

• Disclose disciplinary actions, malpractice claims, or legal issues.
• Answer questions about license sanctions, Medicare/Medicaid sanctions.
• Provide explanations for any reported issues.

11. Upload Supporting Documents

• Upload required licenses, certifications, insurance documents, and identification.

12. Review & Attest Information

• Double-check all information for accuracy.
• Sign the CAQH attestation statement confirming the correctness of the data.
• Submit the profile for payer access and credentialing.

13. Grant Access to Health Plans & Payers

• Select insurance companies and payers who can access your CAQH profile.
• Some payers require manual approval before accessing your data.

14. Maintain & Update Your Profile

• Review and re-attest your CAQH profile every 120 days.
• Update licenses, certifications, work history, and practice details as needed.
• Ensure insurance details and hospital privileges remain current.

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Final Notes

• Keeping your CAQH profile updated is essential for smooth credentialing and provider enrollment.
• Set reminders to re-attest and check for expired documents.
• If you experience any issues, contact CAQH support for assistance.