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FAQ - CAQH Credentialing Process
What is CAQH?
The Council for Affordable Quality Healthcare (CAQH) is a nonprofit alliance of health plans and trade associations designed to simplify healthcare administration through industry initiatives, such as the Universal Provider Datasource.
What is CAQH’s UPD and how will it simplify administrative processes for me?
The Council for Affordable Quality Healthcare’s Universal Provider Datasource (UPD) is a secure online application process that managed care entities or health plans can access for credentialing or re-credentialing providers. The process will allow you to complete your application online and transmit it electronically to participating organizations or print hard copies to forward to non-participating organizations that accept the UPD application.
Where may I obtain additional information about CAQH?
Visit the CAQH Web site at www.CAQH.org
Who will have access to my data?
You must authorize OptumHealth to receive your data. Only healthcare organizations authorized by you will have access to your data. CAQH uses industry-leading technology to protect your information, including redundant firewalls and Secure Socket Layer (SSL) encryption.
I am currently a network provider and I’ve never used CAQH before, how do I know when to complete a CAQH application?
When it is time for you to re-credential, you will first receive a letter from Aperture on behalf of OptumHealth informing you of the need to re-credential. Then, if you are new to CAQH, you will receive a letter from CAQH with your password and ID. Providers must be invited to register with CAQH through a health plan or managed care entity. Register, log on, complete your application, fax any additional supporting documentation to the CAQH data center, and authorize OptumHealth to view your application. Click Here to view the credentialing flow diagram.
I am interested in joining the network. How will I know when to complete a CAQH application?
Once you return your Participating Provider Agreements (contracts) and supplemental documents, we will send your information to CAQH to begin the credentialing process. It is important that you complete all of the information on the supplemental documentation and return it promptly.
I am already registered with CAQH. What do I need to do?
If you already use CAQH, you will receive an email from CAQH asking you to authorize OptumHealth to view your application. Please approve the request and make sure your information and attestation are updated.
What if I have questions about the application or need help completing it?
CAQH has online tools and resources, such as FAQs and reference guides, to assist with application completion. If you need further assistance with the application or experience technical difficulty completing the application, please call the CAQH help desk at (888) 599-1771.
When does my credentialing expire?
URAC (URAC is an organization that accredits OptumHealth’s credentialing processes) requires OptumHealth re-credential providers every three years. CAQH will simplify the process for you because once you complete an application; you simply update your application as needed and re-attest to your information on a quarterly basis. OptumHealth will contact you when you are due for re-credentialing.
When will you begin to credential my specialty/my state using CAQH?
We use CAQH for initial and recredentialing of all DC and CAM providers as well as MPN PT and OT.
I don’t have internet access. Is there another way for me to complete the application?
We encourage you to complete the application online, however we understand in some cases that may not be possible. If you need a paper copy of the application please call the CAQH help desk at (888) 599-1771 to obtain a paper application. Upon completion of the paper application, please fax the application and supporting documentation to CAQH.