Most commercial health plans will not finish credentialing a provider until the provider’s CAQH ProView profile is complete, current and shared with them. A profile that has lapsed is one of the most common reasons a new provider waits weeks longer than planned to bill. This guide explains what CAQH ProView is, what goes into a profile, how re-attestation works and how to avoid the usual problems.
What CAQH ProView Is
CAQH ProView is an online database run by CAQH, a nonprofit alliance of health plans. A provider enters credentialing information once, keeps it current, and authorizes health plans to view it, instead of filling out a separate application for every plan. It is free for providers.
CAQH ProView is used mainly by commercial plans and many Medicaid managed care plans. Medicare enrollment does not use it: Medicare uses its own system, PECOS.
What Goes Into a Profile
- Personal and practice details, NPI and practice locations
- State licenses, DEA registration and board certification
- Education, training and a complete work history, with an explanation for any gaps
- Hospital affiliations or admitting arrangements
- Malpractice insurance and claims history
- Uploaded copies of key documents, such as the license, DEA certificate and malpractice certificate
Re-Attestation Every 120 Days
A provider must review and re-attest that the profile is accurate every 120 days. If the attestation lapses, plans can no longer rely on the profile, and credentialing or recredentialing can stall. Expired documents, such as a malpractice certificate that has renewed, have the same effect, so upload the new copy when it arrives.
The Profile Steps in Order
Set up
- Register or accept the invitation from a plan
- Complete every section and upload documents
- Attest that the information is accurate
Keep current
- Authorize each plan you want to work with
- Re-attest every 120 days
- Upload renewed documents as soon as they arrive
Common Problems and How to Avoid Them
- Lapsed attestation. Put the 120-day date on a calendar for every provider, or let your credentialing company track it.
- Plan not authorized. A plan cannot see the profile until the provider allows it. Check the authorization list before you send an application.
- Expired documents. Licenses, DEA registrations and malpractice certificates renew on different dates. Each renewal needs a new upload.
- Work history gaps. Unexplained gaps slow review. Add a short explanation for each gap.
- Practice locations out of date. When a provider joins or leaves a location, update the profile so directories and claims match.
Who Should Manage It
The provider is responsible for the profile and the attestation, but a practice manager or a credentialing company can be given access to keep it current. If you use a credentialing company, ask how it tracks attestation dates and document expirations for every provider, and whether it will alert you before a date passes. Our guide to how long credentialing takes explains the rest of the process, and you can compare credentialing companies side by side.
