CAQH profile maintenance guide

CAQH ProView is used by most major commercial health plans as part of their credentialing review process. When a practice submits an enrollment application to a participating payer, that payer typically accesses the provider's CAQH profile to retrieve and verify credentialing information rather than asking the practice to submit it again. This makes CAQH maintenance a leverage point in the credentialing process: a well-maintained profile benefits every application, and a neglected profile creates problems across all of them.

Setting up a CAQH account begins at the CAQH ProView website. Providers will need their NPI and basic identifying information to register. Once the account is created, the profile must be completed in full, partial profiles cannot be attested and will not be usable by payers. In some cases, a payer may initiate a CAQH registration invitation for a provider who is applying to join their network; this invitation can also be used to set up the account.

• Create the CAQH ProView account at proview.caqh.org
• Enter accurate contact information for the provider and practice
• Complete all required sections before attempting attestation
• Upload supporting documentation as required for each section
• Authorize payers to access the profile as part of each application

A complete CAQH profile covers all the major credential categories that payers review: personal and professional identification, education and training, work history, licensure and DEA registration, board certification, hospital privileges, professional liability coverage, and malpractice history. Each section has specific required fields, and the profile is not considered complete until all mandatory sections are filled in.

• Personal and professional identifying information including NPI
• Education, residency, and fellowship training details
• Current and past state medical licenses with expiration dates
• DEA registration information, if applicable
• Current malpractice insurance with coverage amounts and effective dates
• Complete work history with no unexplained gaps
• Hospital admitting privileges, if applicable
• Malpractice claims history with supporting documentation

Completing the profile is not a one-time task. CAQH requires providers to re-attest their profile every 120 days to confirm that the information remains current. If a profile is not attested within that window, it becomes inactive, payers can no longer access the information, and any active applications that rely on CAQH data may be delayed or placed on hold until re-attestation occurs.

CAQH sends reminder emails before the attestation deadline, but practices should not rely solely on these reminders. Setting an internal calendar alert for 90 days after each attestation creates a buffer that allows time to review and update the profile before the deadline arrives.

Beyond the 120-day attestation cycle, provider information changes over time, licenses renew, malpractice policies change, employment history is added, and practice locations change. Every material change should be updated in the CAQH profile promptly, not saved for the next attestation cycle. Payers that access stale information during an active application review may request additional documentation or place the application on hold.

• Update CAQH immediately when any license, certificate, or insurance document is renewed
• Update practice location and contact information whenever the practice moves or adds a site
• Review the full profile at each attestation cycle, not just the sections that changed
• Confirm that CAQH information matches what is on file with payers and the NPI Registry
• Upload updated documentation files alongside each information update