CAQH ProView: The Complete Setup and Maintenance Guide for Providers

If you're credentialing with any major commercial payer — Blue Cross, Aetna, UnitedHealthcare, Cigna, Humana — there's a good chance they're pulling your information directly from CAQH ProView. Not from your application. From CAQH.

That means an incomplete, outdated, or lapsed CAQH profile doesn't just slow down one application. It blocks all of them simultaneously — often without any notification that something is wrong.

This guide covers how to set up CAQH correctly, what to keep current, and what happens when you let it lapse.

What Is CAQH ProView?

CAQH (Council for Affordable Quality Healthcare) ProView is a free, centralized database where healthcare providers store their credentialing information. Participating payers — which include virtually every major commercial insurer — are authorized to pull provider data from CAQH instead of requiring providers to submit the same documents to each payer separately.

The system exists to reduce paperwork for providers and payers alike. When it works, it works well. When your profile is incomplete or expired, nothing works.

Step 1 — Register or Claim Your Profile

Go to proview.caqh.org. If you already have an NPI registered with payers, a CAQH profile may already exist for you — search by NPI before creating a new one.

If no profile exists, create one. You'll need:

• Your NPI Type 1 (individual)
• Tax ID (personal SSN or EIN if billing under a group)
• State medical license number
• DEA registration number (if applicable)

Once registered, you'll receive a CAQH Provider ID. Keep this number — payers will ask for it on credentialing applications.

Step 2 — Complete Every Section

CAQH ProView has multiple sections. Payers cannot access your data if required sections are incomplete. Work through each one:

Personal Information

• Full legal name (must match your license exactly)
• Date of birth
• Home and practice address(es)
• Contact information

Education and Training

• Medical school with graduation date
• Residency program and completion date
• Fellowship training (if applicable)
• Board certification — board name, certification number, initial and expiration dates

Work History

• Complete employment history for the past 10 years with no gaps — if there was a gap, explain it
• Current practice: name, address, NPI Type 2, Tax ID, phone, fax

Licenses and Certifications

• State medical license: number, state, issue date, expiration date
• DEA registration: number, schedule, expiration date
• State-controlled substance registration if applicable
• Medicare UPIN (if applicable)
• ECFMG certificate (for international medical graduates)

Malpractice Insurance

• Current carrier name
• Policy number
• Coverage dates
• Coverage limits (minimum $1M per occurrence / $3M aggregate for most payers)
• Named insured — must match how you're credentialing

Disclosure Questions These are yes/no questions about malpractice history, license sanctions, hospital privilege restrictions, and criminal history. Answer honestly — inconsistencies between CAQH and payer primary source verifications are one of the top causes of credentialing delays.

If any answer is yes, attach an explanation statement. Payers expect disclosures; they don't expect surprises.

Supporting Documents Upload scanned copies of:

• Medical license (front)
• DEA certificate
• Malpractice certificate of insurance (COI) — current, not expired
• Board certification certificate
• CV or work history document

Documents must be current. An expired malpractice COI uploaded to CAQH will cause applications to stall.

Step 3 — Authorize Payers

CAQH does not share your data with payers automatically. You must explicitly authorize each payer to access your profile.

After completing your profile, go to Authorize Payers and select every payer you're credentialing with or have an existing relationship with. You can authorize all payers at once — there's no reason not to.

Without authorization, a payer trying to pull your data will see nothing — and your application will stall.

Step 4 — Attest Your Profile

Attestation is CAQH's confirmation that the information in your profile is current and accurate. It is required before any payer can access your data.

Attestation expires every 120 days.

When attestation expires, payers lose access to your profile. Applications in progress stall. Re-credentialing requests time out. The clock doesn't restart until you re-attest.

CAQH sends reminder emails before attestation expires — but those often go to an address no one monitors, or get filtered as spam. The only reliable solution is a calendar reminder set for every 90 days, regardless of whether you've received a CAQH email.

Common CAQH Mistakes That Stall Credentialing

Gaps in work history. CAQH requires a complete 10-year work history with no unexplained gaps. Even a legitimate gap — parental leave, sabbatical, a period of research — needs a brief explanation. Blank periods cause primary source verification failures.

Mismatched name. Your name on CAQH must exactly match your medical license. If your license says "Robert James Smith" and CAQH says "Bob Smith," it's a mismatch. Some payers will flag this; others will process it incorrectly.

Expired documents still uploaded. Uploading a renewed malpractice COI doesn't remove the old one. Archive or delete expired documents so payers don't pull outdated information.

Wrong Tax ID. If you're billing under a group, the Tax ID on CAQH should match the group's EIN — not your personal SSN. This is especially important for practices that have reorganized or changed ownership.

Forgetting to re-authorize new payers. If you're adding a new payer to your contracts, you must add them to your CAQH authorized payer list. They can't pull your data until you do.

Re-Attestation Is Not Optional

The single most common CAQH-related issue we encounter at Medbillytics is expired attestation. Providers who set up CAQH for initial credentialing and don't return for 5 months are suddenly blocked on re-credentialing or new payer applications with no obvious explanation.

The fix takes five minutes: log in, review for accuracy, attest. Set the 90-day reminder now.

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Starting credentialing and not sure if your CAQH is set up correctly? Contact us — we'll review your profile and tell you exactly what's missing before it costs you a credentialing delay.