CAQH ProView
The universal credentialing database used by most commercial payers. Providers must maintain an active, attested profile for enrollment.
CAQH ProView Explained
CAQH ProView (Council for Affordable Quality Healthcare) is the universal provider credentialing database used by virtually every major commercial payer in the United States. Instead of submitting separate credentialing applications to each payer, providers maintain a single CAQH profile that payers pull from during initial enrollment and periodic re-credentialing (typically every 2-3 years). The CAQH profile contains the provider's education, training, licensure, board certifications, malpractice history, work history, hospital privileges, professional references, and demographic information. Providers must attest to the accuracy of their CAQH profile every 120 days — an expired attestation can stall every credentialing action across every payer simultaneously. The most common credentialing failure mode is an expired CAQH attestation that nobody at the practice noticed because the email reminders went to a former staff member. CAQH also operates ProView Direct (used by hospitals for privileging) and several other credentialing-adjacent services. For a new provider joining a practice, completing the CAQH profile fully and accurately is the single highest-leverage credentialing task — it accelerates every downstream payer enrollment by 4-8 weeks.
Related service: CAQH ProView
Go Medical Billing handles caqh proview as a core part of our outsourced revenue cycle service. AAPC-certified team, 2.49% of collections, all 50 states.
See Also: Related Concepts
Credentialing
Verifying a provider's qualifications and enrolling them with insurance payers. Without active credentialing, providers can't bill insurance.
Provider Enrollment
The process of registering a healthcare provider with insurance payers so they can submit claims and receive reimbursement for covered services.
PECOS
Provider Enrollment, Chain, and Ownership System. CMS online system for Medicare enrollment.
NPI
National Provider Identifier. Unique 10-digit number for every healthcare provider and organization. Required on every claim.
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