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Let’s understand what CAQH insurance credentialing is and how to complete the CAQH profile
efficiently.

CAQH, aka Council for affordable quality healthcare, is essentially an online database that contains vital provider information. It is through the CAQH portal that providers grant insurance companies access to their documents, thus making the entire acquisition process quite efficient.

As of 2019, Almost 90 % of all National Health Insurance Companies use CAQH as their primary database for provider information. This includes over 900 health plans, hospitals, and healthcare organizations.

Benefits if Insurance Credentialing with CAQH

The CAQH was founded with a simple objective in mind, to simplify the data gathering process and allow physicians and other healthcare providers with a single source to submit their information. Without CAQH, a typical physician would have to apply separately to multiple insurance companies, each with their own time-consuming process.

However, with CAQH insurance credentialing, this process is simplified, and the time taken for the processing of applications is significantly reduced.

Another benefit of CAQH insurance credentialing is the security the portal offers its users. The CAQH database resides in a secure network operations network. All information here flows to and fro through redundant firewalls. Strict measures like secure internet access, use of passwords, electronic signatures, SSL certificates ensure that the data is only accessed by authentic users.

No cost is incurred by the providers to use the database, whereas health plans and other healthcare providers pay a certain fee per provider to access information.

Completing The Insurance Credentialing CAQH profile.

Completing the CAQH profile is a crucial step in achieving the credentialing process.

There are three steps to get acquainted with the CAQH system. They are as follows.

1) Getting a CAQH Number

There is a higher chance that the insurance company a provider wants to get into a panel that uses CAQH as its provider information database. Check the list of participating organizations on the Council for affordable quality healthcare website to make sure. If your insurance company does use CAQH, then you will receive a CAQH ID number via mail.

Alternatively, you can also self-register with the CAQH portal to get the CAQH number before applying for credentialing.

The number is significant and should not be lost as it will come in handy while re-attesting the information later down the line.

2) Keeping Information Ready

It is recommended to have all the information ready to complete the CAQH profile. The following are the information required:

•  Basic Personal Information
•  Education and Training Information
•  Specialties and Board Certification
•  Malpractice Insurance Information
•  Work History and References
•  Disclosure and Malpractice History

Here are some materials you’ll need:

•  CV or Resume
•  Malpractice or Insurance Policies
•  Drug Enforcement Administration Certificate
•  State Licenses
•  W9’S
•  Various applicable ID numbers

The information on your CV/ Bio Data needs to be perfect and devoid of any errors. It is mandatory to use dates in the CV complying with the following format – MM/YYYY. There should be no gaps in employment. If your date isn’t formatted correctly, or the gaps in your employment are not filled, then your application will be rejected.

3) Completing the Profile

Once we have all the information required to complete the CAQH profile, it’s time to complete it. It is recommended to undertake this process online. The paper-laden method is simply too chaotic to be conducted with efficiency.

It is not mandatory to finish the CAQH profile in one sitting. The application can be saved to be completed on a later date. Once the information is provided, the website will ask you to review the application and attest to its validity.

Once completed, you will have to choose who gets to access it. CAQH portal gives you two options.

• Allow any insurance company that indicates they would like to allow you on their panel to have access to it.
• Manually choose which panels you would like to have access to your information on CAQH portal.

Although the process is complete, you mustn’t lose your approved information. You will be required to re-attest to the information quarterly.
 
CAQH Insurance Credentialing With Denmaar

To complete the CAQH profile efficiently, you need a third-party provider you can trust. Denmaar with years of experience to its credit can help you complete the CAQH profile to make your credentialing experience as convenient and hassle-free as possible.

  Why is the Insurance Credentialing Process So Long?

Thanks to credentialing, any newly hired health professional cannot start work at their new facility for the initial few weeks to six months. Normally, it shouldn’t take providers more than 3 hours as all they have to do is gather all necessary documents and submit them. 

For the facility staff, however, this process can be excruciatingly long. They are responsible for executing several crucial tasks, which include:

• •     Launching a Background Check
• •     Gathering and reviewing the health professional’s credentials, past reputation, and case history. 
• •     Reviewing claims, board history, and privileging
• •     Check sanctions with OIG (Office of Inspector General)
• •     Perform primary source verifications such as medical boards, education history, etc. 
• •     Present files to facility stakeholders, credentialing, and executive committees.

The process has to be repeated every time a new provider is to be credentialed. This makes insurance credentialing extremely frustrating. Communication is often a problem during the execution of these processes and the fact that each facility has its own way of spearheading the credentialing process, makes it even more challenging. 

Other factors, like incorrect or missing information in the application, can delay the process even further. If the credentialing board has a stuffed schedule, then you can expect further delays. As such, you can now understand why many health professionals and institutions consider credentialing to be a never-ending headache. 

  How Much Does Credentialing Cost?

One way to estimate Insurance Credentialing Services costs is by calculating the time a physician would spend on the actual credentialing process. On average, that would be 43 minutes per day.

Now, if we assume that a physician works on $100/hr, that’s approximately $20000/year in credentialing work per physician. This is excluding any paperwork; of course, you lose more money if you lose relevant documents.

In hindsight, you are spending way more than $20000/year. Medical Insurance Credentialing costs way less when outsourced to a third party like DENmaar. Refer to the below breakdown to understand – how much does physician credentialing costs?

Credentialing Cost Breakdown

Individual Physician Cost – 100-200$ per physician

CAQH Database

Initial Setup Costs can go up to $200-$500

Panel Application Cost

Physicians should expect to pay $100 per panel

So, the average cost to credential a physician is somewhere between $2000-$3000/per year. The average cost to credential a nurse practitioner will be more or less the same as well. 

  Why does Credentialing Cost So Much?

Most of the cost incurred in the process of credentialing is because of its lengthy nature. You lose money if you lose your documents. You lose money if you fail to follow up with the insurance companies, resulting in the expiration of your application. The entire process has too many pot-holes for medical practices to crash and burn.

An average physician can lose thousands in income due to this process. Let’s say that a physician makes $299,000. Waiting to render their services for a few weeks due to credentialing will cost them around $25000. Even worse, waiting for six months could cost them an income of around $150,000.

The problem isn’t limited to a few healthcare professionals. In fact, the entire healthcare industry loses billions every year in the USA due to an inept credentialing process. Fortunately, there is a way to avert this disaster and make the credentialing process more cost-effective. 

  Perform Credentialing in a Better way with DENmaar

Credentialing doesn’t have to be as time-consuming or costly as it has been for a long time. All you need are the right credentialing experts shouldering the responsibility on your behalf. This is where DENmaar’s insurance credentialing services come into play. 

DENmaar is home to the credentialing experts, resources, and insight needed to expedite and execute the entire credentialing process in an effective and efficient manner. 

DENmaar offers a fully automated system that provides practitioners with end-to-end solutions to credentialing. You are automatically updated about the status of your application. You get automated re-validation alerts, are assisted throughout the CAQH form filling process, and are alerted of your status application in real-time.

Affordable medical Insurance Credentialing Services cost is possible only when you outsource them to companies like DENmaar.

Fill out the form below or call now on 1-888-595-5100 to get a free estimate.

You have just started a new practice, and you now want to learn about the process of Credentialing Doctors to your group practice. There are many questions that storm the mind before the inception of such a process. Where to begin? Whom to approach? What insurance panels to choose, or how to panel with an insurance company?

The question can be baffling and complex, but not as complicated as the process itself. Those who have undertaken the process know-how stretched out and overwhelmingly complex it actually is. With lots of paperwork, constant follow-ups, and increased risk of loss of documents, it is one hell of an undertaking; many practices wish they would never have to go through. Thankfully, there are third-party Insurance credentialing service providers that can help you immensely with the entire dreadful process by avoiding all of its hassles.

Let’s look at some of the main questions that practices have with regards to insurance credentialing for physicians.

How to Know Which Insurance Companies to Panel With?

You start by asking your colleagues in the same field, or the providers in your own locality about which insurance they are using. Find out all the pros and cons of the insurance companies from them like their rates, promptness of payment, etc. Know which physician credentialing insurance companies are popular in your locality, and which have the most clients’ coverage.

Should You Set Up a Group Contract with Insurance Company?

Some insurance companies allow group contracts, and some don’t. It varies from one company to the other. What is more important to consider is that your clinicians get credentialed using the practices NPI2 and tax ID, and not their own social security numbers. You don’t want to chase all of your clinicians for the checks that were supposed to come to you. Let your clinicians fill out their w9 form with your name, TIN, and address, so insurers know to send the checks to you and not them.

Another benefit of applying as a group is that it is easier to negotiate rates this way than it is to negotiate to be a solo provider. Also, the process of adding clinicians is easier and less time-consuming.

What to do once clinicians have completed their application to participate?

Documents get lost all the time during the process of credentialing. In such a scenario, it is important to follow up with the provider relations departments regarding the receiving of a document. Follow up every week, but do not do it constantly so as not to annoy the already irate officials.

Like we said before, the entire credentialing Doctors process is not without its hassle. We would suggest putting together a Credentialing packet for all your clients with all the credentialing Doctors related information they will need. This will make the entire process easier as every entering therapist will have the knowledge needed for their individual credentialing requirements.

With the help of Denmaar’s credentialing experts,we can walk you through the entire process without any complications and hassle so that you can work on other core areas of your medical practice. You deserve the best physician insurance credentialing services, and we know how to deliver it.