Maximizing Healthcare Efficiency: Mastering CAQH and Provider Credentialing

In today's informative episode, we focus on the pivotal role of CAQH (Council for Affordable Quality Healthcare) in provider credentialing. This video is a must-watch for anyone interested in the intricacies of healthcare credentialing and contracting - from aspiring credentialing specialists to new healthcare managers and individuals keen on understanding this critical area. Exciting news for learners: our comprehensive Healthcare Credentialing and Contracting course is now available on Think GIC, offering valuable insights for those navigating this complex field.
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The links to the CAQH User Guides for providers and practice managers are at the end of this description.
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📚 Looking for more in-depth knowledge? Explore our blog for a wealth of articles on Medical Practice Management, Contracting and credentialing, and more: integralclinicsolutions.com/blog
RESOURCES:
CAQH Provider User Guide: www.caqh.org/sites/default/fi...
CAQH Managers' Access Guide:
www.caqh.org/sites/default/fi...
Hi there! My name is Jennifer. Over the last 15 years, I've gained much experience working in the medical field in various roles. Through my experience, I've seen many medical practice owners make mistakes in running their businesses. That's why I created this channel - to help medical practice owners avoid these common pitfalls. I aim to promote growth and success within the private practice world of medicine. Healthcare has become too standardized, creating many unnecessary challenges and demands.
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[@adasanchez6445]

Hi, your videos have been incredibly helpful. Thank you! I recently started using CAQH and I’m trying to figure out how I can delete the COI that has expired. Again, I can’t thank you enough for all your help.

[@navigatingthebusinessofmed8251]

I wish I could help you because I know that I have done it before, or at least marked it in active, but it’s been a while since I have been in there and without being able to see it it makes it difficult for me. As long as it’s expired or marked in active and you put a new one in there, it should be fine, thanks for watching!

[@betelhemseleshi2978]

Hi, I came across your channel on RUclips and you share some vital information, thank you!
I own an independent Ultrasound facility and I am interested in getting my office credentialed with insurance companies in the area(Maryland). I do have a medical director that oversees my office and I guess my question is that is it all his info that I need to put in when creating CAQH?
Thank you

[@navigatingthebusinessofmed8251]

Does the Medical Director read the results and do you bill for the readings? If so, then yes he would need to be credentialed with all the insurances you will be billing. To become credentialed, the provider would need a CAQH profile created and/or updated for this purpose. Your company needs to be registered with each insurance as a group and a contract. Then once the Med Director is credentialed and approved with each payer, you need to associate them with the group and contract. Good luck!

[@tremealmanley1865]

I am the Owner/Administrator of a BHRF in Arizona. We’re not able to apply for an AHCCCS provider number, the States public healthcare plan, because of a moratorium on new providers. This has greatly hampered our efforts to fully open and accept residents into our facility. The only option we have is to target cash payers. How can applying in CAQH database help us in finding billable residents/clients to prevent closing of the business? Does our BHP need to be in the CAQH database for insurance companies to refer residents to our facility?

[@navigatingthebusinessofmed8251]

Hi there and thank you for watching. I’m sorry to hear of the struggles you’re experiencing. CAQH is used by insurance companies when getting providers credentialed. Not all companies use it. To be referred by an insurance company to your business, you first need to be contracted as an organization with each insurance company and then they will put your providers and group in their online directory under your specialty and address. For other referrals from colleagues, you would need to market yourself to other groups in your area so they know about you and your services. Good luck!