If you are a healthcare provider who is going through the credentialing process, chances are you have heard of the CAQH ProView by the Council for Affordable Quality Healthcare. This is a huge central database that has greatly streamlined credentialing processes. Nonetheless, knowing the CAQH timeline is critical when planning for your practice.

Understanding the CAQH ProView Process 

The CAQH ProView system is a single credentialing information repository for providers. An application is not filed for each insurance company. Instead, one standard application is filed that the approved insurers may access. 

There are a few distinct phases through the complete CAQH process: 

• Initial registration and creating the profile 
• Upload and verification of documents 
• Attesting to the profile 
• Authorization of access to insurers 
• Re-attesting on a regular basis (every 120 days) 

Typical CAQH Timeline Breakdown

The total time from starting your CAQH profile to having it fully accessible to insurers typically follows this timeline: 

Initial Profile Completion: 1-3 Hours

Creating your profile from scratch typically takes 1-3 hours, depending on how organized your documentation is. This includes entering: 

• Personal and professional information 
• Education and training history 
• Practice locations 
• Hospital affiliations 
• Work history 
• License information 
• Professional liability coverage 

Document Upload and Processing: 1-7 Days

After completing your profile, you’ll need to upload supporting documentation such as: 

• Professional licenses 
• DEA registration 
• Malpractice insurance certificates 
• Board certifications 
• Educational diplomas 

Upload is instantaneous, but CAQH processes and verifies these documents usually within 1-7 business days. 

 Attestation Approval: 1-2 Business Days

After the profile has been completed and documentation uploaded, the user must attest to the truthfulness of the information. Attestations are typically processed within 1-2 business days by CAQH.  

Total Time to Active Status: 3-10 Business Days

From start to finish, achieving an active CAQH profile typically takes 3-10 business days, assuming no issues arise during verification. 

In CAQH, although the profile status can show that information is complete, information cannot be accessed till specific authorization is provided. 

Factors That Can Extend Your CAQH Timeline

Some of the common problems that may delay your CAQH processing are, but not limited to: 

Incomplete Information

Profile update delays are most frequently due to missing fields or sections in your profile. All mandatory documentation fields need to be completed for CAQH to process.  

Documentation Issues

Problems with uploaded documents – e.g., expired licenses or documents that cannot be read in the System, will pause processing until resolved.  

Verification Discrepancies

If verification discrepancies exist for provided information or some information is not confirmed, or in case CAQH finds inconsistencies with the information on file and what is provided, they’ll flag your profile for review. 

Holiday Periods

Processing times may take longer during holidays when CAQH staff might be reduced.  

System Maintenance  

Periodic upgrades to the CAQH system can delay the immediate processing of profiles.  

Important Difference: CAQH vs Full Credentialing

A crucial point frequently misunderstood: that filling out your CAQH profile is only one step in total credentialing. Although your CAQH profile may become active within days, complete insurance credentialing usually takes: 

• Commercial payers: 60-120 days 
• Medicare: 90-150 days 
• Medicaid: 60-180 days (varies from state to state significantly) 

Your CAQH profile allows your information available to these entities; it doesn’t replace their internal credentialing processes. 

Tips for Expediting Your CAQH Process 

Follow these tips for the speediest processing possible: 

Prepare All Documentation Before Starting

Make sure all necessary documents are collected and in digital form before you start your profile so that the upload process will be quick. 

Complete All Fields

Optional fields should be completed whenever possible to avoid follow-up requests. 

Use Consistent Information

Ensure all dates, addresses, and other details match exactly across all documents and application fields. 

Check for Expired Documents

Make sure that licenses, certificates, and insurance are not expired before you upload them. 

Set Calendar Reminders for Re-attestation 

CAQH requires re-attestation every 120 days whether or not changes have occurred. Failure to meet this deadline will lead to the inactivation of your profile. 

Respond Promptly to CAQH Queries 

If contacted by CAQH with questions or for more information, respond quickly to avoid further delay.  

Tracking Your CAQH Status 

There are several status indicators in the CAQH system: 

• Initial Profile: You have initiated but not completed your profile 
• Profile Review: Their review of the information you have provided is in progress 
• Incomplete: Your profile has required information that is missing 
• Complete: All required information has been provided 
• Current: Profile is complete and attestation is up-to-date 
• Not Current: The Attestation period of 120 days has expired 

By logging in into CAQH ProView portal he/she can always check the status. 

When to Consider Professional Assistance

If you are running into issues or delays in your CAQH profile, or if you think you may need help credentialing, here are some circumstances where professional credentialing help would be beneficial: 

• You are credentialing for several insurances at the same time 
• Complex practice history 
• Issues are repeating regarding your profile 
• When starting a new practice and there’s no time to waste 

Many providers think the time they save and the stress they avoid make it worth getting some professional help. 

Conclusion

While the CAQH ProView system has significantly streamlined the credentialing process, it still requires careful attention to detail and timely follow-up. Typically, your CAQH profile takes 3-10 business days to become active, so you can plan accordingly. 

Remember that CAQH is just one piece of the overall credentialing process. Planning for appropriate lead time for both CAQH completion and subsequent payer credentialing ensures you can begin billing insurance credentialing service provider companies with minimal delay, maximizing both your practice revenue and patient access to care. 

By preparing well and responding quickly to any verification requests, you can navigate the CAQH process efficiently and focus on what matters most: providing quality care to your patients.