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CAQH Frequently Asked Questions
The Council for Affordable Quality Healthcare is a not-for-profit collaborative alliance of the nation's leading health plans and networks, including Blue Cross NC. CAQH's mission is the improvement of healthcare access and quality for patients and the reduction of the administrative burden for healthcare providers and their office staff members.
The system is a national provider credentialing application initiative from the Council for Affordable Quality Healthcare. The easy-to-use, streamlined database is the single repository of participating health plans for healthcare provider information, alleviating the need for physicians and other healthcare providers to complete and submit many different credentialing forms for multiple health plans, hospitals and other healthcare organizations. More than 300,000 providers are now reducing paperwork and administrative costs through the UCD.
The CAQH Universal Credentialing DataSource is designed make the credentialing process easier for providers by gathering data in a single repository that may be accessed by participating health plans and other healthcare organizations. The DataSource enables providers to easily update their information.
Blue Cross NC works to ensure that the healthcare providers under contract with us are adequately trained, certified and/or licensed to provide care. One of the most integral parts of the credentialing process is the collection and verification of vital data from the provider regarding his or her education, training, experience, practice history, location, disclosure of any issues impacting their ability to provide care, and other background information. Credentialing involves paperwork and administrative time. The CAQH Universal Credentialing DataSource greatly reduces the amount of administrative time required in this process for physicians and other health care providers.
All participating Blue Cross NC providers are eligible to use the CAQH Universal Credentialing DataSource.
A typical physician or other healthcare provider contracts with as many as 10 to 20 healthcare organizations, each of which requires a time-consuming credentialing application. The amount of time associated with the credentialing application process is dramatically reduced through the use of a standard application submitted to a single source. In short, this system means one doctor, one application, and one secure database for all participating health plans. It represents a move from paperwork to more efficient online information gathering.
CAQH worked closely with health plans, physicians, physician professional associations, and accreditation organizations in the development of the system to build an approach that meets the needs of most health plans and other healthcare organizations involved in the credentialing process.
Physicians and other healthcare providers submit their credentialing information to the system database online, or via fax. Organizations requiring provider credentials access the system for the information they require. The CAQH database administrator contacts physicians and other healthcare providers quarterly to update or validate the information via email or fax, and will provide information only to organizations the provider has authorized. Plans will automatically be notified of any updates or changes to provider information.
The database can by accessed via the Internet at http://www.caqh.org. The provider will use a personal ID and password to directly access the database over the Internet. Providers may transmit the completed application electronically, or if they do not have Internet access, may call the CAQH Help Desk at 1-888-599-1771 and request an application to be sent by mail. The provider simply completes the paper copy and faxes it back to a toll-free number.
The CAQH system is secure so that only healthcare organizations authorized by a physician or other healthcare provider have access. Providers have access only to their own data—not that of others.
There are no fees to physicians and other healthcare providers to use the database. Participating CAQH health plans and healthcare organizations pays the costs of developing and maintaining the system.
More information about the CAQH Universal Credentialing DataSource is available on the CAQH Website at caqh.org or by calling 1-888-600-9802.