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CAQH ProView Management: Complete Guide to Provider Attestation & Re-attestation

Introduction: Understanding the CAQH ProView Ecosystem​

If you've ever wondered why healthcare credentialing feels like filling out the same information a hundred different times, CAQH ProView was supposed to be the solution. The Council for Affordable Quality Healthcare (CAQH) created ProView as a universal provider data repository—a single place where healthcare practitioners could maintain their credentialing information, accessible to participating health plans across the country.

The theory was elegant: enter your data once, authorize payers to access it, and eliminate redundant credentialing paperwork. The reality is more nuanced. While CAQH has genuinely reduced administrative burden—studies estimate it saves the healthcare industry $2 billion annually in administrative costs—managing your CAQH profile requires ongoing attention, and mistakes can have serious consequences for your revenue cycle.

Over 1.4 million healthcare providers maintain CAQH ProView profiles, with more than 900 health plans, hospitals, and healthcare organizations accessing this data for credentialing decisions. For most commercial payers, CAQH is the starting point—and often the primary source—of credentialing data. An incomplete, inaccurate, or expired CAQH profile directly translates to credentialing delays, claim denials, and lost revenue.

Automate CAQH Data Entry

AI form-filling tools can pre-populate CAQH profiles from existing provider documents, ensuring accuracy and eliminating redundant data entry. Instafill.ai helps credentialing teams maintain accurate provider profiles that synchronize across CAQH and payer-specific applications.

This guide walks through every aspect of CAQH ProView management—from initial setup through ongoing re-attestation cycles—with practical strategies for maintaining accurate profiles at scale.

Setting Up a CAQH Profile​

Who Needs a CAQH Profile?​

CAQH ProView is required for most healthcare providers who bill insurance. This includes:

  • Physicians (MDs and DOs)
  • Nurse practitioners
  • Physician assistants
  • Psychologists and licensed clinical social workers
  • Physical therapists, occupational therapists, speech therapists
  • Dentists
  • Chiropractors
  • Optometrists
  • Podiatrists
  • And most other licensed healthcare practitioners

If you're a healthcare provider who needs to be credentialed with commercial insurance payers, you almost certainly need a CAQH profile.

Obtaining Your CAQH Provider ID​

Before you can create a profile, you need a CAQH Provider ID. There are several ways to obtain one:

1. Payer-Initiated Registration The most common path: when you apply for credentialing with a participating payer, they may register you with CAQH and send you your Provider ID along with instructions for completing your profile.

2. Self-Registration Providers can self-register at the CAQH ProView website. You'll need:

  • Your NPI number
  • State license information
  • Contact information
  • Specialty information

Self-registration typically takes 3-5 business days for CAQH to process and assign your Provider ID.

3. Practice Administrator Registration For medical groups onboarding new providers, practice administrators can register providers on their behalf through the CAQH portal.

Initial Profile Completion: Step-by-Step​

Once you have your CAQH Provider ID, profile completion involves these sections:

Section 1: Personal Information

  • Legal name (must match state license exactly)
  • Date of birth
  • Social Security Number
  • Contact information
  • Languages spoken
  • Passport-style photograph (optional but recommended)

Section 2: Professional IDs

  • NPI (Type 1 Individual)
  • DEA registration (if applicable)
  • State license numbers for all practice states
  • Medicaid provider numbers (by state)
  • Medicare PTAN/UPIN (if applicable)

Section 3: Education and Training

  • Medical/professional school
  • Graduation date
  • Residency programs
  • Fellowship programs (if applicable)
  • Internships

Section 4: Specialty Information

  • Primary specialty
  • Board certification status
  • Secondary specialties
  • Taxonomy codes

Section 5: Practice Locations

  • All practice addresses
  • Phone and fax numbers
  • Hours of operation
  • Accepting new patients status
  • Languages spoken at each location
  • Accessibility information

Section 6: Hospital Affiliations

  • All hospitals where you have privileges
  • Privilege status (active, courtesy, etc.)
  • Department affiliations

Section 7: Work History

  • Complete employment history (minimum 5 years, often 10)
  • Explanations for any gaps exceeding 30 days

Section 8: Professional Liability Insurance

  • Current malpractice coverage
  • Coverage limits
  • Policy dates
  • Insurance carrier information
  • Claims history

Section 9: Disclosure Questions

  • Licensure actions
  • Hospital privilege actions
  • Professional liability claims
  • Criminal history
  • Substance abuse issues
  • Other relevant disclosures

Document Upload Requirements​

CAQH requires supporting documents for profile verification:

DocumentPurposeNotes
State license(s)Primary licensure verificationCurrent, unexpired
DEA certificateControlled substance authorizationBoth pages
Malpractice insurance face sheetCoverage verificationCurrent policy period
Board certification certificateSpecialty verificationIf board certified
IRS W-9Tax identificationCurrent, signed
Curriculum VitaeProfessional historyRecent, comprehensive

Document quality matters: Uploaded documents must be legible, complete, and clearly show all required information. Blurry scans, partial uploads, or documents with obscured information delay the verification process.

Optimizing Your CAQH Profile for Accuracy and Completeness​

The Completeness Score​

CAQH assigns a completeness score to each profile, indicating how fully the required fields are populated. While a 100% score isn't always necessary (some sections may not apply to your practice), incomplete profiles trigger payer follow-up requests and credentialing delays.

Target a minimum 95% completeness score for the sections relevant to your practice.

Data Consistency: The Most Critical Factor​

The number one cause of CAQH-related credentialing delays is data inconsistency. Your CAQH profile data must match exactly what appears on:

  • Your state license(s)
  • Your NPI registry entry (NPPES)
  • Your Medicare enrollment (PECOS)
  • Individual payer applications
  • Your malpractice insurance documents

Common inconsistencies that cause problems:

FieldExample InconsistencyConsequence
Provider name"Michael J. Smith, MD" vs "Michael Smith MD"PSV verification failure
Address format"123 Main St" vs "123 Main Street"Location verification delays
License numberLeading zero missingLicense verification failure
Specialty"Internal Medicine" vs "Internal Medicine - General"Taxonomy code mismatch
NPIType 1 vs Type 2 confusionApplication rejection

Practice Location Accuracy​

Each practice location in your CAQH profile must include:

  • Complete physical address (not PO Box)
  • Suite or unit numbers where applicable
  • Phone number for that specific location
  • Fax number (still required by many payers)
  • Hours of operation
  • Whether accepting new patients
  • Appointment contact information
  • Accessibility features

Telehealth considerations: If you provide telehealth services, include your telehealth delivery address (typically your home or primary office). Some payers require a physical location even for purely telehealth providers.

Hospital Affiliation Updates​

Hospital affiliations require regular updates because:

  • Privileges expire and need renewal
  • You may add new hospital relationships
  • You may discontinue hospital practice
  • Privilege categories may change (active to courtesy, etc.)

Keep hospital sections current by updating within 30 days of any privilege change.

Disclosure Question Strategy​

The disclosure questions section asks about:

  • Licensure investigations or actions
  • Hospital privilege restrictions or revocations
  • Malpractice claims and settlements
  • Criminal charges or convictions
  • Physical or mental health conditions affecting practice
  • Substance abuse treatment

Answer honestly and completely. CAQH data is verified against the NPDB, state licensing boards, and other primary sources. Undisclosed issues discovered later cause far more damage than disclosed issues explained upfront.

Non-Disclosure = Credentialing Denial

If you answer "No" to a disclosure question and verification reveals the answer should have been "Yes," you face immediate credentialing denial or network termination for material misrepresentation—regardless of how minor the underlying issue might have been.

Malpractice Insurance Section​

This section requires:

  • Current policy effective dates
  • Policy expiration date
  • Coverage limits (typically per occurrence and aggregate)
  • Insurance carrier name and contact
  • Policy type (occurrence vs claims-made)

Claims-made policy holders: If you have a claims-made policy and have changed carriers, ensure your CAQH profile reflects either tail coverage from the prior carrier or a retroactive date on your current policy that covers prior acts.

The 120-Day Re-attestation Cycle​

Understanding the Attestation Requirement​

CAQH requires providers to re-attest to their profile data every 120 days. This isn't just a formality—it's CAQH's mechanism for ensuring data currency. When you attest, you're legally certifying that all information in your profile is accurate and current as of that date.

What Happens at Attestation​

When you log in to re-attest, CAQH will:

  1. Display all profile sections for your review
  2. Highlight any fields that are approaching or past expiration
  3. Prompt you to confirm or update each section
  4. Require you to electronically sign the attestation

The attestation signature is legally binding. You're certifying that:

  • All information is true and accurate
  • You've disclosed any required information
  • You authorize participating organizations to access your data
  • You'll update the profile when changes occur

Consequences of Missing Re-attestation​

If your attestation lapses (goes beyond 120 days), several things happen:

DayConsequence
Day 121+Profile marked as "Not Attested"
Day 121+Payers notified of lapsed attestation
OngoingNew credentialing applications held
OngoingRe-credentialing applications delayed
Varies by payerClaims may be held or denied
Extended lapsePotential network termination

Real revenue impact: Some payers will deny claims for services provided during periods when the provider's CAQH attestation was lapsed. These denials may not be recoverable.

Building a Re-attestation Calendar​

For solo practitioners, a simple calendar reminder 2-3 weeks before the 120-day deadline works. For medical groups managing multiple providers, you need a more systematic approach:

1. Calculate re-attestation dates for all providers Track when each provider last attested and calculate when their next attestation is due.

2. Set reminder cadence

  • 30 days before: Initial reminder to provider
  • 14 days before: Follow-up reminder
  • 7 days before: Escalation if not completed
  • Day of: Urgent notification

3. Assign accountability Designate who is responsible for ensuring attestation completion—the provider themselves, a credentialing coordinator, or a practice manager.

4. Track completion Maintain a log confirming when each re-attestation was completed.

Making Re-attestation Efficient​

Before you log in, gather any documents that may have changed since your last attestation:

  • Updated malpractice insurance face sheet
  • Renewed state licenses
  • New board certifications
  • Updated DEA certificates
  • Changes to practice locations

During attestation, work systematically:

  1. Review each section for accuracy
  2. Update any changed information
  3. Upload new documents where needed
  4. Verify all dates are current
  5. Complete the attestation signature

Average time: A straightforward re-attestation with no changes takes 15-20 minutes. If significant updates are needed, plan for 45-60 minutes.

Managing Multiple Provider Profiles at Scale​

The Challenge of Scale​

Medical groups face a unique challenge: managing dozens or hundreds of CAQH profiles, each with different attestation dates, different credential expiration dates, and different practice location configurations. Without systematic processes, profiles fall out of compliance, creating a constant stream of credentialing delays and claim denials.

If you’re also completing payer-specific credentialing packets alongside CAQH, using an AI form-filler like Instafill.ai can help you reuse the same “source of truth” provider data across many different PDFs and portals, instead of re-keying the same information repeatedly.

Establishing Administrative Delegation​

CAQH allows providers to delegate profile management to administrative staff. To set up delegation:

  1. Provider logs into CAQH ProView
  2. Navigate to "Profile Management" or "Delegation"
  3. Add the administrator's email address
  4. Specify delegation level (view-only, edit, or full access)
  5. Administrator receives invitation and creates their own login

Best practice: Maintain at least two administrators with access to each provider's profile—a primary and a backup.

Standardizing Profile Data​

When managing multiple providers, standardization reduces errors:

Address formatting: Use identical formatting for all providers at the same location

  • "Suite 100" vs "Ste 100" vs "#100" — pick one and use it consistently

Name formatting: Document the exact legal name format for each provider and use it everywhere

  • Include or exclude middle initials consistently
  • Handle suffixes (Jr., III, etc.) the same way

Specialty designations: Use identical specialty descriptions and taxonomy codes for providers in the same specialty

Staggered Attestation Scheduling​

When you have many providers, attestation dates cluster naturally based on when profiles were created. This creates surge periods where many attestations come due simultaneously.

Proactive scheduling spreads the workload:

  1. Identify providers whose attestation dates cluster
  2. Have some providers re-attest early (you can re-attest before the deadline)
  3. Gradually shift attestation dates to spread across the calendar
  4. Target no more than 20% of providers due in any single month

Document Management at Scale​

For organizations managing many providers:

Centralized document repository: Maintain a master file for each provider containing current versions of all CAQH-required documents.

Expiration tracking: Build a calendar tracking when documents expire:

  • State licenses (typically annual or biennial)
  • DEA certificates (triennial)
  • Board certifications (varies, often 10 years)
  • Malpractice insurance (annual)
  • Life support certifications (typically biennial)

Renewal workflow: When a document approaches expiration:

  1. Alert the provider
  2. Track renewal status
  3. Obtain new document when available
  4. Update CAQH profile
  5. Upload new document to CAQH
  6. Update master file

Monitoring Profile Health​

Implement regular audits to catch problems before they cause credentialing issues:

Weekly checks:

  • Attestation status for all providers
  • Any profiles approaching expiration

Monthly checks:

  • Document expiration dates
  • Profile completeness scores
  • Any pending CAQH alerts or notifications

Quarterly checks:

  • Full profile accuracy audit (sample basis for large groups)
  • Consistency verification across systems

Common CAQH Errors That Trigger Claim Denials​

Error 1: Lapsed Attestation​

What happens: Provider's attestation exceeds 120 days.

Consequences: Claims denied, credentialing applications held, potential network termination.

Prevention: Implement attestation calendar with multiple reminder levels.

Error 2: Expired Documents​

What happens: Uploaded documents show expiration dates that have passed.

Consequences: Profile flagged as incomplete, payers request updated documents, credentialing delayed.

Prevention: Track all document expiration dates and update proactively before they expire.

Error 3: Name Mismatches​

What happens: Name in CAQH doesn't exactly match name on license, NPI, or payer application.

Consequences: Primary source verification fails, applications returned for correction.

Prevention: Use legal name exactly as it appears on state license, consistently across all systems.

Error 4: NPI Discrepancies​

What happens: NPI in CAQH doesn't match NPPES registry, or wrong NPI type used.

Consequences: Claim denials, enrollment rejections, billing system failures.

Prevention: Verify NPI against NPPES before entering in CAQH. Ensure using Type 1 (individual) NPI.

Error 5: Missing Practice Locations​

What happens: Provider sees patients at a location not listed in their CAQH profile.

Consequences: Claims denied for services at unlisted location, credentialing incomplete.

Prevention: Add all practice locations immediately when provider starts seeing patients there.

Error 6: Outdated Malpractice Information​

What happens: Malpractice policy dates in CAQH don't match current coverage.

Consequences: Profile flagged as incomplete, credentialing delayed until updated.

Prevention: Update malpractice section immediately when annual renewal occurs.

Error 7: Incomplete Disclosure Answers​

What happens: Disclosure questions answered "Yes" but explanation not provided, or question answered incorrectly.

Consequences: Profile held for clarification, or worse—denial for material misrepresentation.

Prevention: Answer all disclosure questions completely with required explanations.

Error 8: Work History Gaps​

What happens: Employment history shows gaps exceeding 30-60 days without explanation.

Consequences: Payers request gap explanations, delaying credentialing.

Prevention: Include explanations for all gaps directly in the work history section.

Catch Errors Before Payers Do

AI-powered validation tools can cross-reference CAQH data against NPI registry, license databases, and payer applications—flagging inconsistencies before submission. Instafill.ai helps credentialing teams maintain data consistency across all systems.

Which Payers Pull from CAQH vs Require Separate Applications​

Understanding CAQH Participation​

Not all payers use CAQH the same way. Understanding each payer's CAQH integration helps you allocate credentialing effort appropriately.

Major National Payers​

PayerCAQH UsageAdditional Requirements
UnitedHealthcarePrimary sourceSupplemental application for some networks
Anthem/BCBSPrimary sourceVaries by state Blue plan
AetnaPrimary sourceOnline credentialing portal also required
CignaPrimary sourceCigna provider portal registration
HumanaPrimary sourceProvider portal for network selection

Medicare and Medicaid​

Medicare: Does not use CAQH. Medicare credentialing requires separate PECOS enrollment using CMS-855 forms.

Medicaid: Varies by state. Some state Medicaid programs pull from CAQH, others require completely separate applications. Check your state's Medicaid provider enrollment requirements.

Regional and Specialty Payers​

Regional payers and specialty health plans vary widely in CAQH integration:

  • Many regional Blues plans use CAQH as primary source
  • Workers' compensation carriers generally don't use CAQH
  • Dental plans may or may not use CAQH
  • Behavioral health carve-outs sometimes have separate processes

Always verify each payer's specific CAQH integration before assuming your profile data will flow automatically.

Data Authorization​

Having a CAQH profile isn't enough—you must authorize each payer to access your data. Without authorization, payers cannot pull your information even if their systems integrate with CAQH.

To authorize payers:

  1. Log into CAQH ProView
  2. Navigate to "Plan/Organization Authorization"
  3. Search for the payer by name
  4. Select authorization level (typically "Full Authorization")
  5. Save authorization

Review authorizations annually to ensure all active payer relationships have current authorization.

Integrating CAQH with Payer-Specific Credentialing Workflows​

The CAQH-Payer Data Flow​

When you authorize a payer and apply for credentialing, here's what typically happens:

  1. Payer receives your credentialing application
  2. Payer queries CAQH for your profile data
  3. CAQH returns your attested data
  4. Payer compares application data against CAQH data
  5. Discrepancies trigger follow-up requests
  6. Payer performs primary source verification on CAQH data
  7. Credentialing committee reviews complete file

Key insight: Payers treat CAQH as a data source, not a verified credential. They still verify licenses, certifications, and other credentials through primary sources.

Ensuring Data Synchronization​

When you update information in one system, update it everywhere:

CAQH update triggers:

  • Update NPPES (NPI registry)
  • Update PECOS (if Medicare enrolled)
  • Notify payers of material changes
  • Update payer portals where applicable

Payer update triggers:

  • Verify CAQH reflects the same information
  • Confirm NPPES is current
  • Update internal credentialing database

Managing Payer-Specific Requirements​

Even payers that use CAQH have additional requirements:

Common supplemental requirements:

  • Payer-specific contracting forms
  • Network participation agreements
  • Fee schedule acknowledgments
  • Payer portal registration
  • Additional attestations (fraud/waste/abuse, cultural competency, etc.)

Build payer-specific checklists that identify requirements beyond CAQH for each major payer in your market.

Handling CAQH-to-Payer Discrepancies​

When payers report discrepancies between your application and CAQH:

  1. Identify the specific discrepancy (request details if not provided)
  2. Determine the correct information (verify against source documents)
  3. Update CAQH if the profile is incorrect
  4. Confirm the update propagates by checking CAQH reflects the change
  5. Notify the payer that the discrepancy has been resolved
  6. Document the resolution for your records

Automation Strategies for CAQH Management​

The Case for CAQH Automation​

Manual CAQH management becomes unsustainable as provider count grows. Consider the workload:

ProvidersAnnual AttestationsEstimated Manual Hours
103015-30 hours
5015075-150 hours
100300150-300 hours
5001,500750-1,500 hours

Add document updates, profile corrections, and payer-specific work, and CAQH management alone can consume a full-time position for every 50-100 providers.

Automation Opportunities​

1. Attestation Tracking and Reminders

Automated systems can:

  • Calculate attestation due dates from last attestation
  • Send escalating reminder sequences
  • Track completion status
  • Alert managers to overdue attestations

2. Document Expiration Monitoring

Automation can:

  • Extract expiration dates from uploaded documents
  • Calculate renewal timelines
  • Alert when documents approach expiration
  • Track renewal progress

3. Data Entry and Updates

AI-powered tools can:

  • Extract data from provider documents automatically
  • Pre-populate CAQH fields from existing data
  • Identify inconsistencies across systems
  • Suggest corrections based on source documents

This is especially helpful when your team already maintains provider packets (CV, licenses, malpractice COI, W-9, etc.) and needs to push consistent data into CAQH plus downstream payer forms—workflows that tools like Instafill.ai are designed to automate.

4. Profile Validation

Automated validation can:

  • Cross-reference CAQH data against NPPES
  • Verify license status against state board databases
  • Check for completeness score issues
  • Flag potential discrepancies before attestation

Implementing CAQH Automation​

Start with tracking: Before automating data entry, implement robust tracking of attestation dates and document expirations. This alone prevents most CAQH-related problems.

Add validation: Implement automated checks that compare CAQH data against source systems, flagging inconsistencies for human review.

Consider AI form-filling: Modern AI tools can extract data from provider documents and populate CAQH fields automatically, dramatically reducing manual entry time and errors.

For example, Instafill.ai can turn source documents (CVs, licenses, malpractice COIs, W-9s, etc.) into consistent, submission-ready CAQH and payer-application data—especially useful when you manage dozens (or hundreds) of providers and need the same information to stay synchronized across systems.

See CAQH Automation in Action

Healthcare organizations using AI-powered credentialing platforms report 85% reduction in CAQH management time. Learn how EightAI scaled from 350 to 1,250 providers with credentialing automation including CAQH management.

Measuring CAQH Management Efficiency​

Track these metrics to identify improvement opportunities:

MetricManual BenchmarkAutomated Target
Attestation on-time rate85-90%99%+
Time per attestation20-45 minutes5-10 minutes
Document expiration misses5-10%Less than 1%
Profile errors caught pre-submission50-60%95%+

Conclusion​

CAQH ProView sits at the center of commercial payer credentialing. An accurate, current, well-maintained profile accelerates credentialing, prevents claim denials, and reduces administrative burden. A neglected profile creates a cascade of problems that ripple through your revenue cycle.

The core principles are straightforward:

  1. Set up completely: Don't leave sections incomplete. Upload all required documents. Answer all questions.

  2. Maintain consistency: Your CAQH data must match your NPI registry, your state licenses, your payer applications, and every other system where your provider data appears.

  3. Never miss re-attestation: Build systems—automated or manual—that ensure you re-attest before the 120-day deadline every single time.

  4. Update proactively: When documents renew, when practice locations change, when hospital affiliations shift—update CAQH immediately, don't wait for attestation.

  5. Authorize appropriately: Ensure every payer you work with has current authorization to access your CAQH data.

For organizations managing multiple providers, the investment in systematic CAQH management—tracking systems, document management, automated reminders, AI-assisted data entry—pays dividends in reduced credentialing delays, fewer claim denials, and credentialing staff freed to focus on complex cases rather than routine attestations.