What a payer checks before it reads your CAQH profile

Most commercial payers read a provider's CAQH ProView profile instead of sending a questionnaire of their own, and each still takes its own application.^A When the profile has a gap, the payer seldom refuses. It holds the file and asks, and the clock stops until someone answers.

Run this list for each provider before a single application goes out. It needs no login and saves nothing; the boxes clear when you leave the page.

The checklist.

0 of 8 checked

The attestation is current. CAQH asks each provider to re-attest on a set cycle. A lapsed profile reads as out of date.^B
The name matches NPPES exactly. Including any change after marriage, on both records.^C
The practice address matches, suite and all. CAQH, NPPES and the application should read the same.
The specialty taxonomy is today's. Not the one from residency or a former job.
The profile is released to every plan you file with. A plan left off the release list cannot open it.
Every document is unexpired. State license, DEA registration, board certification and the malpractice certificate.
The work history has no silent gap. Any break carries a short written explanation.
Every location is listed. Each site where the provider sees patients, matching the practice's own list.

What to do with an unticked box.

Fix NPPES first, because the other records copy from it. Then bring CAQH into line, re-attest, and check the release list against the plans on your filing order. A document due to expire while a commercial application is open is worth renewing early, since commercial plans take months to decide.^A

If the list turns up more than a few gaps, that is the work the Payer Enrollment Sprint does before anything is filed. CAQH setup or repair is $150 per provider. The field note on CAQH mistakes explains each check in more depth.

Sources

GetPracticeHelp, credentialing timelines by payer type. A vendor guide without a sample, cited for how enrollment is structured and the broad order of payer timing.
Credentialing vendors' published summaries of CAQH ProView re-attestation.
CMS, NPPES, the national register of NPIs, and its public NPI files.

What a payer checks before it reads your CAQH profile. Tick it off yourself. No sign-up.

The checklist.

What to do with an unticked box.

Unticked boxes? We close them before anything is filed.