For healthcare providers, practice managers, and owners, efficient credentialing is crucial. The Council for Affordable Quality Healthcare (CAQH) simplifies this process, acting as a central repository for provider information used by over 90% of national health insurance companies. It streamlines applications to multiple insurers, saving valuable time and resources. But what happens when your CAQH profile expires? The consequences can be significant.
Why CAQH Matters (and Why Delays Happen)
CAQH eliminates the need for repeated submissions of documents like work history and medical licenses to individual insurers. They can access this information directly from your CAQH profile. This efficiency is why CAQH is a prerequisite for insurance enrollment in many states.
However, several issues can delay the CAQH process:
- Illegible Documents: Unclear or low-resolution scans can cause processing hiccups.
- Missing or Expired Documents: Outdated licenses, malpractice insurance, or other required credentials halt the process.
- Outdated Information: Changes to your information (address, contact details, etc.) that aren’t promptly updated create discrepancies.
The Impact of an Expired CAQH Profile
Failing to attest or re-attest your CAQH application can have serious repercussions:
- Credentialing Delays or Rejections: Your applications with payers will be stalled or denied, impacting your ability to contract with insurers.
- Payment Disruptions: Reimbursements can be delayed or even rejected, creating cash flow problems for your practice.
- Manual Updates: If your CAQH profile expires, you’ll have to individually update your information with each insurance company, wasting time and resources.
- Compromised Credibility and Efficiency: An outdated CAQH profile reflects poorly on your practice and hinders operational efficiency.
- Impact on Patient Care: Delays in credentialing and payments can ultimately affect your ability to provide timely patient care.
Proactive Prevention: Keeping Your CAQH Profile Current
Preventing CAQH expiration is straightforward. Regular maintenance is key:
- Regular Attestation: Attest your CAQH application every 180 days to maintain an active profile and provide insurers with current information. Many organizations implement internal reviews every 90-120 days for added vigilance.
- Timely Updates: Immediately update your CAQH profile whenever you receive a new malpractice policy, license, DEA certificate, W9, or experience a change of address.
- Document Verification: Ensure all submitted documents are legible and complete. Attesting each document confirms its completeness and facilitates a smooth process.
Don’t Let an Expired CAQH Profile Disrupt Your Practice
Maintaining a current CAQH profile is essential for smooth credentialing, timely payments, and efficient practice operations. By proactively managing your profile and adhering to the recommended attestation schedule, you can avoid costly delays and ensure your practice runs smoothly.
Need Help Managing Your Credentialing Process?
Managing credentialing and CAQH can be time-consuming. eClinicAssist offers expert credentialing services to help you stay on top of your CAQH profile and other essential administrative tasks. Contact us today to learn how we can streamline your processes and free up your time to focus on patient care.
