CAQH Profile Development & Maintenance

Navigating the complexities of creating or updating CAQH ProView profiles can be particularly challenging for therapists. Our service simplifies this process by assisting therapists in compiling, submitting, and maintaining all required information, adhering to the highest industry standards and regulatory requirements. 

Creating a CAQH profile is critical for therapists who wish to be credentialed with various insurance payers. The process involves providing comprehensive and precise documentation to ensure no credential delays, ultimately facilitating seamless insurance transactions for therapy services. 

Document Requirements for CAQH Profiles 

• Liability Insurance: Proof of current professional liability insurance is essential. This document must include the policy number, effective dates, and coverage amounts. Liability insurance not only protects the practitioner but is also a requirement by most insurance networks for credentialing. 
• Up-to-Date Resume: A complete and current resume must be submitted. It should detail all educational background, certifications, and employment history, specifically highlighting any experience relevant to the therapy specialty. Crucially, the resume must include all current practicing locations with accurate addresses and contact information. This ensures that the insurance payers have a clear understanding of where the services are provided. 
• License and Certifications: Information of current state licenses and certifications, such as Board Certified Behavior Analyst (BCBA) credentials, are mandatory. The information validate the professional's qualifications and legal authorization to practice. 

Regular Updates and Attestations

Therapists are required to re-attest their CAQH profiles every 120 days. This attestation confirms that all the information provided remains current and accurate. Additionally, whenever there is a change in any document or practice information, such as a new practicing location or a renewed insurance policy, the CAQH profile should be updated immediately to reflect these changes.

By diligently maintaining their CAQH profiles, therapists ensure that their practices are well-positioned to deliver uninterrupted, high-quality therapy services covered by various insurance payers, thus fostering a stable and compliant practice environment.

Profile Review and Verification: Our team thoroughly reviews all details on the CAQH profiles for accuracy and completeness. We verify that all required documentation, such as liability insurance certificates, current licenses, and updated resumes, are correctly uploaded and reflect the current status of the behavior analysts.

Documentation Cross-Checking: We cross-check all documents against primary sources where possible and ensure that they meet the specific requirements of each insurance payer with which the therapist is affiliated. This includes checking the validity of documents and ensuring that all practice locations are accurately listed.

Error Identification and Correction: During our audits, we identify any discrepancies or outdated information that could potentially lead to credentialing delays or denials. We promptly address these issues by updating the CAQH profile and re-attesting as needed to maintain continuous compliance and readiness for insurance audits.