Take the Pain Out of Credentialing

Take the Pain Out of Credentialing

How Eye Care Professionals Benefit from CAQH

No doubt you are aware of CAQH (the Council For Affordable Quality Healthcare). But here is what you need to know about CAQH.

It is the go-to data bank for storing health care provider information. Providers grant access to their information to insurance companies, who then decide whether they will approve providers for in-network contracts. Ninety percent (90%) of insurance companies use CAQH to pull and review an optometrist’s credentials to provide certified care.

An optometrist simply plugs in his or her licenses, certifications, malpractice insurance, and practice history.

But updating data is not a one-and-done process. It must be updated every four months—a task that can slip through the cracks when a doc is focused on day-to-day patient care. If your CAQH profile is not up-to-date, however, your insurance providers might stop paying claims. You might be surprised at how many doctors think their CAQH is up-to-date—and they haven’t actually done it in a year or more, despite the automatic reminders sent by CAQH to review and attest to the accuracy of the account.

We at RevCyle Partners recommend that doctors use CAQH. It may seem like a hassle, but there are at least three reasons it can benefit your eye care practice:

  1. Simplifies your paperwork. Credentialing paperwork is a time-sink for optometrists and their billing staff. On average, an eyecare provider contracts with 10 – 20 healthcare organizations. Each require an extensive and complete credentialing application.

    CAQH streamlines the process by allowing providers to submit one standard credentialing application to one database used by 90% of insurance companies. This translates into significantly less paperwork associated with the ongoing task of credentialing.

  2. Centralizes your data.You might think you have more control keeping credentialing in-house. But the process is multi-faceted.

    Each request entails a six- to twelve-page information request. If you are filing with multiple insurance plans, this task can swallow up hours. What is costly becomes more costly as you add on hours for follow-up discussions with the insurance companies.

  3. Receive automatic reminders. An eyecare practice’s data must be updated at least once every four months—or when your practice adds a doctor.

    Once you’ve been credentialed by CAQH, they automatically send reminders for you to update your account. The key is to not ignore the reminders as they come in. If you don’t update regularly, you might have to start from square one – that is, resubmit an entirely new application.

    Many insurance billing companies offer maintenance plans that will reach out when a CAQH needs to be attested.