CAQH

CAQH is the universal credentialing data system that you can use to apply for network provider applications with various insurance companies instead of filling out the same redundant application for each separate company.

You have the option to complete the application online or through 50 pages of paper.  As with the Medicare application, I see absolutely no reason to fill out the paper application.  In fact, I’ve read online that the paper applications are notorious for getting lost or delayed  because some data entry employee on the other side has to manually enter all your information on a computer.

The online application isn’t without any challenges either however.  The main website: http://www.caqh.org/ is quite confusing to navigate.  The section you want use is the Universal Provider Datasource, which you can find at: https://upd.caqh.org/oas/.

Finding where to go on the CAQH is only half the battle.  The CAQH user ID registration process is just as cryptic.  In order to register with CAQH, you will first need a CAQH provider ID, of which the FAQ section describes,

“Physicians and other healthcare professionals must have a contractual arrangement with a UPD-participating plan, hospital, or other healthcare organization to use the service. Once rostered in UPD, physicians and other healthcare professionals will be invited to participate by CAQH via mail. They will be sent a Provider ID number needed to access UPD and submit their information online.”

I thought that this comment meant that I needed to already be on an insurance plan to obtain a provider ID, which would have been a catch-22 if you’re not on any insurance plans like me.  Thankfully, it’s not true.  In order to obtain a CAQH provider ID, you just have to contact any insurance company that participates with CAQH, and to request a network provider application and to be placed on the company’s CAQH roster.

I used Aetna to obtain my CAQH provider ID.  You can learn all about it at: http://www.aetna.com/faqs-health-insurance/health-care-professionals-join-network.html.  It was nice that I could take care of my request online, instead of over the phone.  I received my CAQH provider ID in the mail about a week after I had filled out the request.  Finally, I was able to register, and to begin my CAQH application.

By now, I’ve become a pro at completing credentialing applications.  I pretty much just had to transfer over all the information on my hospital privileges application. You’ll need the standard information, which includes the numbers for your state license, DEA, NPI, Medicare, and USMLE.  You’ll also need to provide information regarding your medical education, postgraduate training, board certification/eligibility, practice location, hospital privileges, and malpractice insurance.  Once you fill everything out, you’ll need to fax a signed attestation and release form, supporting documents, and signed W-9’s.

When you complete this application, you’ll have the option to authorize any insurance company that places you on their physician roster.  Since I started out with Aetna, it was the only company officially on my list.  However, I chose the option to also authorize any other insurance company that I solicit in the future to access my application as well.

Ironically, I’ll be contracting with Aetna PPO through my IPA.  I’m still keeping my individual application with Aetna open so that I can sign up for their HMO, EPO, POS, etc.

Once your CAQH application is complete, you can request other insurance companies for an application and for placement on their roster.  You can find most provider credentialing department phone numbers on the FAQs, policies & procedures sections, or network invitation tabs of the provider pages for each insurance company.  You can probably also just call their main numbers as well.  Some companies will  have online request forms and others will make you inquire over the phone.

Since I’ll be on most plans through my IPA, I just needed to request to join Anthem Blue Cross and Cigna.  Blue Shield of California does not participate with CAQH by the way.  I still haven’t received a supplemental application package from Cigna, so I don’t know what’s next with them.  As for Blue Cross and Aetna,  they sent me a provider contract that I needed to sign.  What I hear is that the companies will hold onto this contract until my credentialing is approved, after which they will fully execute and activate.  According to the companies, this whole process should take 60 to 90 days.  I’m hoping for 60.

As for how I chose which insurance companies to apply, I just went on to my hospital’s physician directory, and looked at what plans the other existing ophthalmologists were on, and followed suit.  You can also either do a Google search or call your local hospital or ophthalmologist to see which insurance companies have the largest representation in your area.

OK.  So, I feel like I’m nearing the end of my paper trail.  I still need to apply for Blue Shield and Medi-Cal though, and I’ll go over them next.

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