Credentialing Frequently Asked Questions



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CAQH is the Council for Affordable Quality Healthcare, Inc., a not-for-profit collaborative alliance of the nation’s leading health plans and networks. The mission of CAQH is to improve health care access and quality for patients and reduce administrative requirements for physicians and other health care providers and their office staffs. CAQH’s participating organizations provide health care coverage for more than 300 million Americans.


The CAQH Universal Provider Datasource® (UPD) service is the industry standard for collecting provider data used in credentialing and member service resource. A single, standard online form—the CAQH application—is the centerpiece of the UPD service. Providers in all 50 states and the District of Columbia are able to enter their information free of charge through an interview-style process. Through its streamlined, electronic data collection process, UPD is helping to reduce unnecessary paperwork while saving millions of dollars in annual administrative costs for more than 800,000 physicians and other health professionals, as well as more than 550 participating health plans, hospitals and health care organizations.


No. Providers may utilize the UPD at no cost


Yes. The CAQH application (UPD form) meets the data-collection requirements of URAC, the National Committee for Quality Assurance (NCQA) and the Joint Commission standards. Indiana, Kansas, Kentucky, Louisiana, Maryland, Missouri, New Jersey, New Mexico, Ohio, Rhode Island, Tennessee, Vermont, and the District of Columbia have adopted the CAQH standard form as their mandated or designated provider credentialing application.


BCBSTX chose to work with CAQH because the UPD is a proven solution for simplifying administrative burdens placed on providers during the credentialing/recredentialing process. The easy-to-use online data collection and application process means less paperwork for BCBSTX providers, with built-in auditing tools to help increase efficiency and maintain data security and integrity. BCBSTX also considered independent user studies further assessing the track-record of the UPD.

Based on figures from a Medical Group Management Association (MGMA) cost analysis, CAQH estimates that the UPD has already eliminated more than 2.4 million legacy-credentialing applications resulting in savings of $95 million per year or more than 3.2 million hours (the equivalent of 1,561 full-time employees) of provider and support staff time required to complete and send redundant application forms.


Yes. All providers, required to submit a credentialing or recredentialing application, must utilize the CAQH database. Exception: Texas physicians and other professional providers who do not have a provider type listed in the “CAQH Approved Provider Types” list below must go to the TDI website to access and complete a Texas Standardized Credentialing Application, and fax or mail the completed application along with the required supporting documents referenced below to BCBSTX:

 

CAQH Approved Provider Types

Standard Provider Types

Medical Doctor (MD), Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DMD), Doctor of Podiatric Medicine (DPM) Doctor of Chiropractics (DC), Doctor of Osteopathy (DO)

Allied Provider Types

Acupuncturist (ACU), Audiologist (AUD), Biofeedback Technician (BT), Alcohol/Drug Counselor (ADC), Christian Science Practitioner (CSP), Clinical Nurse Specialist (CNS), Clinical Psychologist (CP), Clinical Social Worker (CSW), Professional Counselor (PC), Licensed Practical Nurse (LPN), Massage Therapist (MT), Marriage/Family Therapist (MFT), Naturopath (ND), Neuropsychologist (NEU), Midwife (MW), Nurse Midwife (NMW), Nurse Practitioner (NP), Nutritionist (LN), Occupational Therapist (OT), Optometrist (OD), Optician (DT), Physicial Therapist (PT), Registered Dietician (RD), Registered Nurse (RN), Certified Registered Nurse Anesthetist (CRNA), Registered Nurse First Assistant (RNFA), Respiratory Therapist (RT), Speech Pathologist (SLP)

 

Required Supporting Documents

  • State medical license(s)
  • Drug Enforcement Administration (DEA) Certificate
  • Controlled and Dangerous Substances (DPS) Certificate
  • Malpractice insurance face sheet
  • Summary of any pending or settled malpractice case(s) - if within 10 or less years old
  • Curriculum Vitae
  • Signed Attestation (page 18 of online application – print & sign)
  • Written Protocol (Nurse Practitioners only

Forward completed application packet to BCBSTX:

Fax to: 972-996-8230 (preferred method)

or

Mail to:

Blue Cross and Blue Shield of Texas
          Attn: Provider Administration
          P.O. Box 65067
          Dallas, TX 75265-0267


When you apply for network participation, BCBSTX will add you to its roster with CAQH. If you do not have a CAQH ID number, CAQH will send you a registration letter with your ID. If you already have a CAQH ID and your information is complete and current and you have authorized BCBSTX, CAQH will provide your information to BCBSTX.


CAQH will typically send a registration letter within 24 hours of receiving a provider on a roster. New Mexico providers added to a roster for recredentialing purposes will receive a registration letter in the timeframe specified by New Mexico state regulations for recredentialing notifications.


If you already have a CAQH ID number, you may update your information at any time. BCBSTX will roster you in advance of your next recredentialing due date. If you do not have a CAQH ID number, CAQH will send you a registration letter with your ID.


Once you are rostered by BCBSTX, access and registration instructions will be sent to you from CAQH. You will use a personal ID and password to obtain immediate access to the UPD via the Internet. You may submit your completed application online and fax supporting documents to a specified toll-free fax number (866) 293-0414. If you have any questions on accessing the database, you may contact the CAQH Help Desk at (888) 599-1771 for assistance or you may send an email to caqh.updhelp@acsgs.com.


Yes. In states where legislation has passed mandating the use of a standard credentialing application form, the data collected through CAQH UPD and data collection process will include the data elements and/or form as is required by the state. The system will automatically ask the necessary questions to fulfill the requirements for the state in which the provider's primary office address is located.


The primary goal of CAQH UPD is to simplify the administrative process with a robust and streamlined data system. While the CAQH credentialing data set is substantially complete, BCBSTX may need to supplement, clarify, or confirm certain responses in the application with individual physicians and other health care providers on a case-by-case basis. Therefore, you may be required to provide supplemental documentation in some situations, in addition to the information you submit through UPD.


BCBSTX has selected CAQH UPD as its data collection source for credentialing and recredentialing applications. We will access CAQH UPD for your data at initial credentialing and during your scheduled recredentialing cycle every third year. You must continue to directly notify BCBSTX of any changes to your practice information or status.


The confidentiality and security of provider information and the privacy of system users are critical priorities for CAQH. The UPD design is compliant with laws, rules, and regulations relating to the privacy of individually identifiable health information. In addition, CAQH complies with applicable laws and regulations pertaining to confidentiality and security in development of the database and the data collection process. The CAQH database is housed in the U.S. within a secure Network Operations Center. You may contact the CAQH Help Desk with additional questions by calling (888) 599-1771 or by email.


You will be sent automatic reminders to review and attest to the accuracy of your data. You must review and authorize data once every four (4) months. This is accomplished through an online visit to https://upd.caqh.org/oas/ or by calling the CAQH Help Desk at (888) 599-1771 for assistance.


Because BCBSTX will be using this system for credentialing and recredentialing, it is important that the CAQH/UPD database contains the most accurate and up-to-date information. By reviewing and attesting to your data three (3) times a year, you will enable BCBSTX to obtain current information from the CAQH/UPD database at the time of recredentialing or database updates, without having to contact you repeatedly. This will help you continue to conform to the requirements of your network contract.


No. You control which health plan(s) have access to your CAQH application information. When completing the application, you will have the option of granting global access to your application data, or you may choose to select which participating health plan(s) and health care organization(s) you want to view your data.


No one can access your application data except for the health plan(s) that you have authorized.


Your Social Security Number is required to complete the application and will be used to verify your credentials.


If you do not have Internet access, you may call the CAQH Help Desk at (888) 599-1771 and complete the application by telephone. Supporting documents may be faxed toll free to (866) 293-0414.


Yes. Hearing/sight challenged providers may call the CAQH Help Desk at (888) 599-1771 and complete the application by telephone. Supporting documents may be faxed toll free to (866) 293-0414


The CAQH Help Desk provides telephone service Monday through Thursday, from 5 a.m. to 7 p.m., MT, and Friday, from 5 a.m. to 5 p.m., MT, to assist with any questions you may have. You may reach the Help Desk by calling (888) 599-1771 or by email.