CAQH Credentialing
Council for Affordable Quality Healthcare
The CAQH ProView database used by most commercial payers to credential providers.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Enrollment
- Acronym for
- Council for Affordable Quality Healthcare
- Primary sources
- 1
- Workspace handoff
- compliance binder →
Where this comes up
Credentialing and revenue-cycle staff handle this — CAQH ProView upkeep, payer-roster validation, NPI maintenance, PECOS revalidation cycles, and the gap between application and effective date that strands new providers. Lapses here block payment until backdated re-enrollment closes the gap.
Full definition
What it is in practice
CAQH is a centralized provider data utility. Most commercial plans pull credentialing data from CAQH rather than separate paper applications. Providers must re-attest the data every 120 days.
How it shows up in your practice
Build a 90-day reminder for CAQH re-attestation. Lapsed attestation is the most common cause of commercial credentialing delays.
Sources
- CAQH — Provider Data Portalhttps://www.caqh.org/solutions/credentialing
Track CAQH attestation in the Compliance Binder
Open compliance binder →Related terms
- EnrollmentNPI (National Provider Identifier)The 10-digit HIPAA standard identifier for health care providers.
- EnrollmentCredentialingThe process by which a payer verifies a provider's qualifications and grants participation in the network.
- EnrollmentProvider Enrollment RevalidationCMS requirement to periodically re-submit and validate enrollment information to remain Medicare-enrolled.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryCredentialingThe process by which a payer verifies a provider's qualifications and grants participation in the network.
- GlossaryNPI (National Provider Identifier)The 10-digit HIPAA standard identifier for health care providers.
- GlossaryProvider Enrollment RevalidationCMS requirement to periodically re-submit and validate enrollment information to remain Medicare-enrolled.
- GlossaryHospital CredentialingThe process by which a hospital medical staff verifies and grants privileges to a physician.
- GlossaryPrimary Source VerificationVerification of a provider's credentials directly from the issuing source (e.g., medical school, residency, state licensing board).
- GlossaryRecredentialingThe periodic re-verification of provider credentials, typically every three years for most commercial payers.
- RegulationCMS-855A: Medicare Enrollment for Institutional ProvidersMedicare enrollment application for institutional providers including hospitals, CAHs, hospices, home health agencies, federally qualified health centers, rural health clinics, and similar entities.
- RegulationCMS-855B: Medicare Enrollment Application for Clinics and Group PracticesThe Medicare enrollment application for clinics, group practices, and certain other suppliers — the primary enrollment vehicle for medical practices that bill Part B.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.