CAQH Provider Data Portal

Provider User Guide

Version #43
Last Updated: 08/22/2023

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 Provider User Guide
Version #43
Last Updated: 08/22/2023
© 2023 CAQH All rights reserved

Contents
1. Introduction ................................................................................................................................................... 4
1.1. CAQH Provider Data Portal Overview .................................................................................................... 4
1.2. Getting Started ....................................................................................................................................... 4
2. Registration ................................................................................................................................................... 5
2.1. New Users .............................................................................................................................................. 5
2.2. Existing Providers................................................................................................................................... 5
2.3. Self-Registration ..................................................................................................................................... 6
2.4. Creating a CAQH Provider Data Portal Account .................................................................................... 8
2.5. Creating a CAQH Provider Data Portal Username and Password ......................................................... 8
2.6. Retrieve Username .............................................................................................................................. 11
2.7. Reset Password ................................................................................................................................... 12
2.8. Change Primary Email ......................................................................................................................... 14
2.9. Forgotten or Unknown CAQH ID Number ............................................................................................ 18
2.10. Check for a CAQH ID ........................................................................................................................... 23
3. Home Page .................................................................................................................................................. 25
3.1. Attest Reminder Bar ............................................................................................................................. 29
3.2. Attest Button ......................................................................................................................................... 29
3.3. Activity Log ........................................................................................................................................... 30
4. Completing Your Profile Information ........................................................................................................ 31
4.1. Personal Information ............................................................................................................................ 34
4.2. Editing SSN and DOB .......................................................................................................................... 39
4.3. Professional IDs ................................................................................................................................... 43
4.4. Education & Professional Training ....................................................................................................... 48
4.5. Specialties ............................................................................................................................................ 54
4.6. Practice Locations ................................................................................................................................ 58
4.6.1 Practice Details .................................................................................................................................... 68
4.6.2 Duplicate Location Records ................................................................................................................. 70
4.6.3 Provider at the Location ....................................................................................................................... 80
4.6.4 Services and Resources ...................................................................................................................... 86
4.6.4.1 Payment and Remittance ................................................................................................................. 89
4.6.5 Archiving a Location/s ........................................................................................................................ 100
4.6.6 Restoring an Archived Location/s ....................................................................................................... 106
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 4.6.7 Health Plan Participation .................................................................................................................... 110
4.6.8 Help Patients Find You ....................................................................................................................... 110
4.7. Hospital Affiliations ............................................................................................................................. 112
4.7.1 Admitting Privileges ............................................................................................................................ 114
4.7.2 Admitting Arrangements ..................................................................................................................... 116
4.7.3 Non-Admitting Affiliations ................................................................................................................... 118
4.8. Credentialing Contact ......................................................................................................................... 122
4.9. Professional Liability Insurance .......................................................................................................... 123
4.9.1 Renewing an Expired PLI Record ...................................................................................................... 132
4.10. Employment Information .................................................................................................................... 136
4.11. Professional References .................................................................................................................... 144
4.12. Disclosure .......................................................................................................................................... 144
4.13. Authorize ............................................................................................................................................ 145
4.13.1 Update Authorization ..................................................................................................................... 146
5. Review Your Data ...................................................................................................................................... 147
5.1. Correct Errors ..................................................................................................................................... 148
5.2. View Documents ................................................................................................................................ 150
5.3. View Your Data Summary .................................................................................................................. 151
5.4. Download Your State Application ....................................................................................................... 151
6. Uploading Supporting Documentation ................................................................................................... 152
6.1. Uploading Documents ........................................................................................................................ 152
6.2. Authorization, Attestation, and Release Form (AAR Form) ................................................................ 153
6.3. Failed Documents .............................................................................................................................. 154
6.3.1 North Carolina Providers .................................................................................................................... 155
6.3.2 AAR for Oklahoma Providers ............................................................................................................. 156
7. Importing Data from the Practice Manager Module ............................................................................... 158
7.1. Drag & Drop Functionality .................................................................................................................. 159
8. Completing Your Attestation ................................................................................................................... 159
8.1. Attesting ............................................................................................................................................. 159
8.2. Re-Attesting ....................................................................................................................................... 162
8.3. Re-attestation Reminder Emails ......................................................................................................... 164
8.4. Resources and Training ..................................................................................................................... 164
Appendix ............................................................................................................................................................. 165
Provider Status ................................................................................................................................................ 165
Training Information ......................................................................................................................................... 166
Help Desk Information...................................................................................................................................... 166
Revision Log .................................................................................................................................................... 167

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1. Introduction
The purpose of this document is to guide you as a provider through the process of entering your profile information
into the CAQH Provider Data Portal to meet a variety of data needs of health plans, hospitals and other healthcare
organizations. It also defines the steps to authorize, attest and maintain your data profile through the re-attestation
process.

1.1. CAQH Provider Data Portal Overview

The CAQH Provider Data Portal is the healthcare industry’s premier resource for providers to self-report
professional and practice information to payers, hospitals, large provider groups and health systems. The CAQH
Provider Data Portal eliminates duplicative paperwork for these organizations that may require provider profile
information for claims administration, credentialing, directory services, and more.

Through an intuitive, profile-based design, you can easily enter and maintain your information for submission to
your selected organizations. The CAQH Provider Data Portal can be accessed at https://proview.caqh.org/pr and is
free to use.

The following steps provide you with a high-level overview of the process to complete your data profile.

1. Register with the system.

2. Complete all application questions.
3. Review your data profile for accuracy.
4. Authorize participating organizations access to your data profile.
5. Attest to your data profile.
6. Upload your supporting documentation.

This document will provide additional information and helpful tips for each of these steps.

1.2. Getting Started

Completing the initial CAQH Provider Data Portal profile may take up to two hours; however, preparing yourself for
the information requested will reduce the time required to complete your profile. Additional time may be required
depending upon several factors, including the number of practice locations, amount of postgraduate training and
work history, and overall familiarity with online tools and systems.

The CAQH Provider Data Portal is fully supported on the current version of Chrome web browser. The application is
compatible with Internet Explorer, Safari, Edge, and Firefox though may not be fully supported.

If your practice has an office manager or clinic administrator who assists with gathering information for credentialing
or other administrative purposes for multiple providers, the CAQH Provider Data Portal for Practice Managers may
facilitate your data entry process. Data that is the same for multiple providers (e.g., clinic name, address, and phone
number) can be entered once by a practice manager, rather than having to be entered repeatedly for each
individual provider. Please refer to Chapter 7: Importing Data from the Practice Manager Module for more
information regarding this functionality. Your administrator may also wish to explore the CAQH Provider Data Portal
for Provider Groups; learn more here: https://www.caqh.org/solutions/provider-data/credentialing-suite/register-for-
groups.

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2. Registration
Registration is required for all providers to obtain access to the CAQH Provider Data Portal.

2.1. New Users

If you received an introductory email from the CAQH Provider Data Portal, select the link contained in the email to
begin the registration process using the CAQH ID provided. Refer to “Creating a CAQH Provider Data Portal
Account” on page 9 of this guide for the next steps in the process.

2.2. Existing Providers

For providers who were previously registered, go to the CAQH Provider Data Portal at https://proview.caqh.org/pr.
You can initially sign-in by entering your username and password and clicking “Sign in”. You may be prompted to
update your username and password at this time. Refer to “Creating a CAQH Provider Data Portal Username and
Password” on page 9 of this guide for the next steps in the process.

CAQH has come up with a standard maintenance and deployment window for the CAQH Provider Data Portal. It
will be static and will remain on the login page at all times.

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2.3. Self-Registration
If you have not received a Welcome Letter, you may begin the self-registration process by accessing the CAQH
Provider Data Portal at https://proview.caqh.org/pr and clicking on “Register”. The “Getting Started” page will
display and will provide you with additional tips on how to get started. Click on “Go to Next Section” to continue with
the registration process.

To establish a CAQH Provider Data Portal account, you will be required to enter your NUCC Grouping, Provider
Type, name, address, primary practice state, birthdate, email address, and the following personal identification
numbers: Social Security Number, NPI Number, DEA Number, License State, and License Number. If you do not
have an NPI, a DEA or a License, you may click their corresponding checkboxes indicating you don’t have them
and click Continue. You will then receive an email with your CAQH Provider ID and a link to complete your provider
registration.

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2.4. Creating a CAQH Provider Data Portal Account
New CAQH Provider Data Portal users who either self-register with the system or who are added to the system by
an organization, will receive an email from CAQH Provider Data Portal containing a CAQH Provider ID and a link to
create a CAQH Provider Data Portal account.

Upon selecting the link from the e-mail, you received, you will be directed to the page shown below. Enter your
CAQH Provider ID and select “Continue”.

On the next screen, enter your personal identification number(s) to proceed with creating your Provider Data Portal
account. Select “Continue” to proceed.

2.5. Creating a CAQH Provider Data Portal Username and Password

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Usernames in the CAQH Provider Data Portal must consist of 8 characters and can be any combination of numbers
and/or letters. Special characters like # or @ are not allowed.

CAQH users will also be asked security questions to facilitate account access in case of a forgotten username
and/or password. Select three security questions and provide unique answers for each. By checking “I Agree” at
the bottom of the page, you adhere to the terms and conditions, which can be accessed by selecting the “See
Terms and Conditions” hyperlink. Then select “Create Account”.

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Click “Create Account” and you will receive confirmation that your CAQH Provider Data Portal registration was
successful.

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2.6. Retrieve Username
1. If you have forgotten your username, go to the CAQH Provider Data Portal login page and click Forgot
Username.

2. You will be prompted to enter your CAQH Provider ID number to retrieve your username. Your CAQH Provider
ID number is the unique identifier assigned to you in the CAQH Provider Data Portal at the time of registration.
Enter your CAQH Provider ID number. Click the checkbox indicating that you have read and agree to the CAQH
Terms of Service.

3. Click the checkbox to confirm you are not a robot. You’ll be asked to select images based on the instructions
shown on the page, then click Verify.

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This page also shows some tips for troubleshooting.

4. Click Continue. Your username will be displayed on the screen together with your CAQH Provider ID number
and the primary e-mail address listed on your account. You have the option to save it as a PDF file. If you know
your password and you’d like to proceed to the sign-in page, click “Log In”.

2.7. Reset Password

1. If you have forgotten your password and need to reset it, you may click the Forgot Password button from the
screen above or the Forgot Password link on the log-in page.
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Note: If you entered an incorrect password and clicked “Sign In” five times, you will be redirected to the Forgot
Password page. You have the option to either reset your password or go back to the log-in page to enter the correct
password.
2. You will be prompted to enter your username to be able to proceed. Click the checkbox indicating that you have
read and agree to the CAQH Terms of Service, then click Continue.

3. You will be directed to a page where you need to enter your full e-mail address based on the hint shown on the
screen. The e-mail shown here is the primary e-mail address on your CAQH Provider Data Portal profile where
email notifications and reminders are sent. Click Continue.

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An e-mail containing a link which will allow you to reset your password will be sent to the primary e-mail address we
have on file.

2.8. Change Primary Email

1. If you are trying to reset your password and you don’t know or don’t have access to the primary e-mail address
on file, click the Change Primary Email link.

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2. You will be directed to a quick security check. Answer any three questions on the page. You will be able to click
the Continue button found at the bottom of the page only if three questions were answered.

3. You may enter the last four digits of your Social Security Number. If you have a Board Certification, click the
radio button for “I have Board Certification”. You will be asked to enter your Provider Type and the Name of
Certifying Board. You may also enter your Professional Liability Insurance Expiration Date and/or your Professional
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Liability Insurance Policy Number. The policy number must be entered exactly as it is shown on your policy face
sheet. This may include alphabetical and special characters, as well as leading zeros. Once any three questions
were answered, the Continue button will turn red and you will now be able to click it. Click Continue.

4. If the details that you have entered during the verification process do not match the details on the profile, you
will be prompted with a message that says “Sorry, we could not verify your account based on the information
provided. Please try again!”

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5. If you have passed the verification process, you will be directed to a page where you can enter the new primary
e-mail address you would like to use for your account.

6. We recommend that you use an e-mail that you check regularly. Please note that once this change is made,
your profile will be permanently updated and all CAQH notifications will be sent to this new e-mail address. Click
Save.
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7. An e-mail containing a link which will allow you to reset your password will be sent to the new primary e-mail
address.

Note: The new e-mail address will be reflected on your profile only after you click the password reset link sent to
the new e-mail address.

2.9. Forgotten or Unknown CAQH ID Number

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1. If you cannot proceed with the process of retrieving your username or resetting your password because you do
not know your CAQH Provider ID number, click the Forgot CAQH Provider ID link found at the bottom of the Forgot
Username page.

2. To help us find your account, enter your first and last name (do not include your title, degrees, prefix or suffix).
Enter your Individual or Type 1 NPI or your date of birth. Answer the question “Are you a Doctor of Dental Medicine
(DMD) or Doctor of Dental Surgery (DDS)?”. Click the checkbox indicating that you have read and agree to the
CAQH Terms of Service, then click Continue.

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If the information that you have entered does not match your account details, you will be prompted with a message
saying, “Sorry, we could not find an account that matched your information. Please try again!”

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If your account matched the details that you have entered, you will be directed to a quick security check.

3. Answer any three questions on the page. You will be able to click the Continue button found at the bottom of
the page only if three questions were answered. You may enter the last four digits of your Social Security Number.
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If you have a Board Certification, click the radio button for “I have Board Certification”. You will be asked to enter
your Provider Type and the Name of Certifying Board. You may also enter your Professional Liability Insurance
Expiration Date and/or your Professional Liability Insurance Policy Number. The policy number must be entered
exactly as it is shown on your policy face sheet. This may include alphabetical and special characters, as well as
leading zeros. Once any three questions were answered, the Continue button will turn red and you will now be able
to click it. Click Continue.

If the details that you have entered during the verification process do not match the details on the profile, you will be
prompted with a message that says “Sorry, we could not verify your account based on the information provided.
Please try again!”

If you have passed the verification process, your CAQH Provider ID number will be displayed on the screen. You
can now proceed with retrieving your username.

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2.10. Check for a CAQH ID
This new feature allows providers to self-lookup a CAQH Provider ID directly in the Provider Portal.

When using this functionality, you will be redirected to the enhanced Provider Self Registration page where you will
enter your personal information to receive your CAQH account information if one already exists.

If the updated Provider Matching Logic confirms a profile match, the retrieved CAQH ID will be displayed and will
allow you to take the appropriate next steps.

If the existing account has username and password already set up, the screen will show the following: Username,
CAQH ID Number, and primary e-mail address.

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If the existing account doesn’t have a username and a password set up yet, the user will be directed to this page
showing the CAQH ID number and a Continue button that will let you set up your username and password and
security questions and answers.

Enter your personal identification number/s in the field/s on the screenshot below.

Click Continue to proceed to the page where you can set up your username and password and security questions
and answers.

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3. Home Page
You will see the CAQH Provider Data Portal Home page after a successful login.
The homepage will display a new design to show how much of your profile remains required to complete.
The completeness percentage, number of required questions remaining, and the last updated date will be
displayed next to each page within the Profile Data section. The overall completeness rate will display at the top of
the sections as well.
If all required fields for a page are complete, the provider will see a green progress bar and check mark. If required
fields are missing data or a validation error exists on a page, the provider will see a blank progress bar, or a yellow
bar if some information has been submitted. The Profile Data section will be expanded by default if there are
required fixes remaining.

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The updated homepage will also provide the user with information around any documents that need attention. If a
document is missing, expired, or otherwise has errors, it will be displayed in the Documents section. If
any document fixes are required, then this section will be expanded by default.

If the Profile Data or Documents section do not have any outstanding required fixes, then they will be collapsed by
default. The provider can also manually collapse or expand the sections, as shown in the screenshot. Below the
collapsible sections, links to Directory Data, Data Summary, and State Application will also be displayed.

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A Broadcast Message feature has been added to the CAQH Provider Data Portal Provider, Practice Manager, and
Participating Organization portal. Broadcast Messaging will allow CAQH to communicate upcoming system updates
and/or to report system-wide issues to all users.

Whenever there is a published broadcast message, a pop-up message will appear on your screen when you log in
to your CAQH Provider Data Portal account.

If you click the ‘X’ located at the top, the pop-up message will close but will re-appear upon your next log-in.

If you click the Dismiss button, the pop-up message will close and will NOT appear with future log-ins. If you clicked
the Dismiss button and would like to view the broadcast message again, click on the CAQH Provider Data Portal
Provider Update link found above your name.

Tip:
o If you need assistance on the Home Page, you can access the “FAQ” link that is displayed in the top right-hand
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 corner on the Home Page.

In addition, to these components, across the top of the home page is a navigation menu, which allows you to
navigate to four sections to complete your profile information:
• Profile Data – Click this tab to enter your profile information (See Chapter 4)
• Documents – Click this tab to review your supporting documents (See Chapter 6)
• Authorize – Click this tab to view the list of the organizations that have requested authorization to view your
CAQH Provider Data Portal self-reported information

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3.1. Attest Reminder Bar
o After you update any information in your profile, you must complete attestation so that your authorized
organizations can view your updated profile.
o A reminder message will appear across the top of the page on every page only after you have changed one or
more piece of data and have not attested to that change.
o This message will disappear only after you have attested but would re-appear if you changed more data and
did not re-attest.
o This message will also appear if CAQH has updated a relevant domain table value.

3.2. Attest Button

• The ‘Attest’ navigational element can be found right below the Authorize tab.
• If you are logging in for the first time, you will see a message “First complete your Profile Data, then Review
and Attest”. This part of the header will guide providers to profile completion.

The message will change to “Next: Submit your documents for approval” as soon as you have completed your initial
attestation and the status is changed to Profile Data Submitted.

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Once all the required documents are approved and the status changes to Initial Profile Complete, the messaging
will change to: “<number of days> until your next attestation Last attested <date> See history”. The same
messaging shows if the status of the account is Reattestation.

When the status changes to Expired Attestation, the messaging also changes to “<number of days> past attestation
Last attested <date> See history”

3.3. Activity Log

From the Home Page, you can access the “Activity Log” from the top right navigation drop-down menu.

The Activity Log lists all recent activity that has occurred in your account, including recent log-ins, re-attestations,
and data updates.

Note:
o All changes on the profile will ONLY appear on the Activity Log after you have completed the re-attestation.
o Any changes done after the re-attestation will not be reflected on the Activity Log unless you complete the re-
attestation again after making the additional changes.
o If after the re-attestation these changes are still not reflected on the Activity Log, sign out from the CAQH

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 Provider Data Portal and log in again and go to Activity Log. The details of the changes should appear on this
page of your profile.
o Changes on the Documents section and Authorization page will reflect on the Activity Log even if you have not
yet re-attested.

4. Completing Your Profile Information

The CAQH Provider Data Portal will guide you through the process of completing your information and managing
your profile data and supporting documentation. From the Home Page, click on “Profile Data” on the top navigation
bar to begin the process.

Tips:
o Throughout the system, required fields are indicated with a red asterisk (*).
o If you need assistance, you can access the “FAQ” link that is displayed on the right-hand side of the screens.
o Use “Save and Go Back” or “Save & Continue” to page backward or forward within sections.
o It is important to click on the “Save” button or the “Save & Continue” button to save your information. Clicking
on the back and forward arrows via the left-hand navigation will also save your information.

Clicking on “Profile Data” shows a drop-down list of 11 Sections: Personal Information, Professional IDs, Education
and Professional Training, Specialties, Practice Locations, Hospital Affiliations, Credential Contacts, Professional
Liability Insurance, Employment Information, Professional References, and Disclosure. They are described in
further detail below. Questions presented to you may vary based on your primary practice state.

The Profile Data and Documents tabs will be updated to indicate the completion of the application. An “X” will
indicate that the provider is missing required information and a checkmark will indicate that all sections are
completed for profile data as well as Documents.

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The Profile Data section within the header displays:
o A Yellow indicator when profile is 1-99% complete
o A green indicator when the profile is 100% complete

The Documents section within the header displays:

o A red indicator when mandatory documents are missing, invalid, error, etc.
o A green indicator when all mandatory document errors are resolved.
o When mandatory documents are in the approved status a green indicator will show.
o If no document slots exist in profile, the portal will show a green indicator.

Completeness visual indicators will be displayed within the profile header drop-down menu and on the left-
navigation.

If required fields are missing data or a validation error exists on the page, the user will see a red X indicator for the
section. If the required fields are complete and no errors exist, the user will see a green check mark for the section.
The full profile completeness is displayed in the progress bar in the profile header drop-down menu.

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Upon “Save” or “Save and Continue” or “Save and Go Back” the provider will see any required fix displayed on the
page at the top of the page. If a required field is missing data, the user will see a red validation error at the top of
the page and the corresponding field will be highlighted red on the page with an error message indicating to enter
data into the required field.

CAQH continues to help providers submit accurate data by displaying errors at the top of the page and by
highlighting relevant field(s). This ensures providers have a consistent error-handling experience as they progress
through their profile. Fields with data entry errors will also be highlighted.

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4.1. Personal Information
The Personal Information section requests basic information such as name, phone numbers, and contact
information. Some information on this screen may be pre-populated based on the information you entered during
the self-registration process. Additional information or tips are provided below as applicable to assist you with
completing these fields.

Tips:
If you need assistance, you can access the “FAQ” link that is displayed on the right-hand side of the screens.
Use “Save & Continue” to save the changes made on the page and move to the next section.
It is important to click on the “Save” button or the “Save & Continue” button to save your information. Clicking on
the back and forward arrows via the left-hand navigation will also save your information.

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The Personal Information page has been redesigned to improve the CAQH Provider Data Portal user experience
for all providers.
• Profile Set Up
o New providers will be asked to enter their NUCC Grouping. The Provider Type, Specialties and
Certifying Boards will now be based on the NUCC Grouping that you have selected.
o Existing providers will see NUCC Grouping populated with a value that was based on the existing
specialty on the profile. If you have not previously entered a Specialty, the NUCC Grouping
showing on your account was based on your Provider Type.
o Providers who have not previously entered their Specialty nor their Provider Type will see a blank
field for NUCC Grouping. This field will appear on the Correct Errors page as a required fix.
o Provider Type Not Listed has been added to the dropdown for the Provider Type field. Select this
value only if your provider type is not in the options.
o When entering Additional Practice States, click the multi-selection dropdown. A list of practice
states will be displayed alphabetically. Click the checkbox of the state/s that you want to add as
other practice state/s. To remove a state, click the X button next to the state.
o Your NUCC Grouping, Provider Type, Practice Setting, and Practice State will drive the questions
presented to you throughout CAQH Provider Data Portal’s profile sections. If you practice in
multiple states and one of those states includes a state specific credentialing application, the state
specific questions and the CAQH Provider Data Portal standardized questions will be presented to
you in one integrated flow throughout the system. You will be required to complete all required
questions for both the CAQH Provider Data Portal standardized profile questions as well as any
state specific questions.
• Home Address
o Not required to complete your application; however, hospitals have identified that this information
adds value in confirming your accessibility to the hospital.
o Click the Add button should you wish to add your home address.
• Mailing Address
o Enter the “Mailing Address” of the physical location of your practice. If you do not have a physical
practice location, you may enter a P.O. Box; however, it is important to note that health plans
intend to use this information for their directories. If you would like to enter a P.O. Box for the
billing address, please enter this information in the Billing Contact section.
o Click the Add button to add your mailing address.
o If your mailing address is the same as your home address, click the checkbox for “Mailing address
and home address are the same.”

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 • Contact Information (The additional e-mail fields will only display in expanded view if you have
previously entered details on these fields. Otherwise, only the required field Primary E-mail will be
displayed.)
o Primary E-mail – Important system reminders will be sent to this e-mail address, so be sure to
keep this information current.
o Additional E-mails – You may enter additional e-mail addresses; in case you use other
professional e-mail accounts or have staff that maintains your profile.
▪ Additional E-mail 1 – You may use this field for your personal e-mail address.
▪ Additional E-mail 2 – If you have previously entered an e-mail address as PMOC CC
Email 1, that e-mail address will appear on this field.
▪ Additional E-mail 3 – If you have previously entered an e-mail address as PMOC CC
Email 2, that e-mail address will appear on this field.
o Provider’s Phone Number – Click the Add button to add your phone number. Existing
providers who have previously entered their phone number, that details will be displayed on
this field.

• Personal Identification Numbers

o Your Social Security Number is required to complete the application.
o NPI – National Provider Identification Number
▪ This is a provider’s Type 1 National Provider Identifier. It is a unique, 10-digit
identification number issued to health care providers by the Centers for Medicare and
Medicaid Services (CMS).

Note: All Type 1 NPIs will undergo validation. A Type 1 NPI is validated against the provider’s name and number
in the NPPES (National Plan & Provider Enumeration System). Registry validation failures will be displayed as an
error on the Personal Information page and as a required fix on the Correct Errors page.

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You may see the following errors on the Required Fixes page:
o This NPI number cannot be found in the NPPES NPI Registry. – This means that the Type 1 NPI that
entered in the CAQH Provider Data Portal is an invalid one. Please review for any possible typo error.
o This is an Organization (Type 2) NPI. Please enter an Individual NPI. – You may have entered a Group
NPI in the Individual NPI field. Please review the value that you have entered in the Individual NPI field.
o The name associated with this Individual NPI number in the NPPES Registry does not match the names
associated with your profile. If this is your NPI, please make sure your Name or Other Name in the CAQH
Provider Data Portal matches the name associated with your Individual NPI in the NPPES Registry. –
Please review the Individual NPI that you have entered. There might be a typographical error that has
caused the mismatch.

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Providers who have previously indicated that they do not have a Type 1 NPI will be prompted to review this
question again to see if it now applies to them.

This will appear on the Personal Information page once every 24 hours to confirm this response is still accurate for
the provider.

The Correct Errors page will also display the NPI confirmation error once every 24 hours.

For Providers whose Provider Type is either MD, DO, NP, or DMD with Inpatient/Outpatient or Outpatient Only as
the Practice Setting, the Primary Practice State and each of the other Practice States (in case of multi-state
Providers) should have a matching value populated for the State field in the General information section for any
active Practice Location (where you answered Yes to the question: Do you practice at this location?). There will be
an error for each Practice State that does not match an active Practice Location.

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On the screenshot above, the practice state on the account is New York but there is no active practice location in
New York listed in the profile. The Provider is required to either add an active practice location in New York or
remove New York as a primary practice state, whichever is applicable.
o The Update Practice States hyperlink in the error links to the Personal Information Page. Once the user
has clicked the hyperlink, the following error is displayed on the top of the Personal Information Page, in
red text:

You have selected {Primary Practice State or Practice State} as a practice state but you have not indicated
that you practice at a location in {Primary Practice State or Practice State}. Please add a practice location
in {Primary Practice State or Practice State} or remove {Primary Practice State or Practice State} as a
practice state.

o If you add a practice location to match the Practice State, and click “Save and Continue”, you will be
redirected to the Correct Errors Page and will no longer see the error.
o The Ignore hyperlink in the error links to the Ignore pop-up that already exists for Address Standardization.
The pop-up should have the same functionality, i.e., if the user clicks the “Yes” button, the error is removed
from the Correct Errors Page.
o You are required to either fix the error or click Ignore and then click “Yes” in the pop-up so that the error
disappears on the Correct Errors Page, and you will be able to attest.

4.2. Editing SSN and DOB

With the aim of providing enhanced security for provider profiles, the CAQH Provider Data Portal locks the SSN and
DOB for editing after the first attestation has occurred.
o Providers who have attested for the first timewill no longer be permitted to change their Social Security
Number.

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o Once the profile has been completed and attested, the Date of Birth will no longer be editable.

o Helpful information is located in the CAQH Provider Data Portal FAQ tab under the “Why are the Social
Security Number and Date of Birth fields read-only?” question.

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o Providers who have never attested in the CAQH Provider Data Portal will be able to edit their SSN and
DOB fields.

• Demographics
o Gender Identity
o Birth Date
o Birth City
o Birth State
o Birth Country

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o Race/Ethnicity – Select the options that apply. You may click the Add button to provide additional detail
about your background.

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 o Languages

4.3. Professional IDs

The Professional ID section requests that you enter all professional identification numbers and upload any
applicable supporting documentation. If you have questions on uploading your documentation, refer to Chapter 6:
Uploading Supporting Documentation.

Tips:
o If you need assistance, you can access the “FAQ” link that is displayed on the right-hand side of the screens.
o Use “Save and Go Back” or “Save & Continue” to page backward or forward within sections.
o It is important to click on the “Save” button or the “Save & Continue” button to save your information. Clicking
on the back and forward arrows via the left-hand navigation will also save your information.
o Select “Add” to enter additional medical licenses or other professional identification numbers.
o If the “Import” button is active, information already entered by a practice manager is available for you to view
and import if you choose to do so.

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The following professional identification numbers are requested in the Professional IDs section.
• Medical License
o You must enter all state medical licenses you currently hold or have held as issued by a U.S.
or Canadian licensing authority.
o You will only be allowed enter numbers, letters, dashes, and periods in the License Number
field.
o Professional licenses will be displayed in the form of a grid displaying the License State,
Currently Practicing (Yes or No), License Number, and Expiration Date.
o Click the Edit link to update the license details.
o Click the Delete link to remove the license record.
o Click the Add button to add a professional license record.
• DEA Registration – Drug Enforcement Administration
o DEA eligible providers are required to enter their DEA details by clicking the Add button.
• CDS Registration – Controlled Dangerous Substances
o CDS eligible providers should enter their CDS details by clicking the Add button.

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 • Those who choose not to prescribe should click the checkbox for “I do not prescribe”, select the reason for
not having a DEA Registration, and should indicate an Alternate Prescriber Name.

If you choose “My patients do not require controlled substances”, you will be required to provide more information.

If you select “Other”, you will be required to provide an explanation.

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DEA eligible providers can now indicate if they have a Buprenorphine Waiver by clicking the checkbox for I have a
Buprenorphine Waiver when adding a new DEA record or editing an existing record.

• CDS Registration – Controlled Dangerous Substance

o Click the Add button to add a CDS Registration record

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Providers practicing in AZ are not required to enter a CDS record. Providers who have previously entered a CDS for
AZ will be prompted to delete the record the next time they log in.

If you are a provider trying to add a CDS record for AZ, you will be prompted with the following message.

• Medicaid
• Medicare
• ECFMG
o This is a certificate issued by the Education Commission for Foreign Medical Graduates and
applies to US Citizens who graduated from a Medical School outside the United States.
• USMLE – United Stated Medical Learning Examination
o The United States Medical Learning Examination is a physician assessment required for physician
licensing in the United States.

All the required field for Professional IDs (License, DEA, CDS) should be filled out completely for it to be saved.
One unanswered required field will keep the Continue and Save and Add Another button disabled, hence,
incomplete information will not be saved.

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4.4. Education & Professional Training

The Education information will be placed at the top section of the page. The Education section requests information
regarding your education history, including your professional and undergraduate school information.

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Tips:
o If you need assistance, please access the “FAQ” link that is displayed on the right-hand side of the screen.
o Use “Save and Go Back” or “Save & Continue” to page backward or forward within sections.
o It is important to click on the “Save” button or the “Save & Continue” button to save your information. Clicking
on the back and forward arrows via the left-hand navigation will also save your information.
o Click on “Add” to add additional education record as necessary.
o If the “Import” button is active, information already entered by a practice manager is available for you to view
and import if you choose to do so.

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When you add a new record or access an existing record, you will see a new “Education Type” field. Beneath this
field, there are 3 radio buttons for Undergraduate, Professional School, and Fifth Pathway.

When creating a new education record, the Education Type Name value will default to Professional School. Hover
over the tooltip for additional information and instructions.
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When creating a new education record, the country should default to United States. If you select Fifth Pathway as
the Education Type, United States should be the only option. When you select Undergraduate as the Education
Type, no fields are required.

Note: Providers who have previously saved education records will not be subject to additional field requirements.
The Professional Training subsections are listed below:
• Internship
o Include any incomplete internship programs.
• Residency
o Include any incomplete residency programs.
o If your training program was Rotating or Transitional, please enter a separate entry for each
rotation. For credentialing, the health plans need to know the specifics of each rotation
including the specialty or department and the time associated with each.
• Fellowship
o The period of medical training in the United States and Canada that a physician or dentist may
undertake after completing a specialty training program (residency)
• Faculty Positions/Academic Appointments

Click the Add button to add a Professional Training section.

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You will be directed to a page where you can enter your Professional Training details.

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If there are existing records for these 2 sections, the user shall be able to Edit or Remove the existing record/s.

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 o The user should add at least 1 education record.
o The Degree will be displayed on the left side of the card instead of the Education Type name value
(Undergraduate, Professional School, and Fifth Pathway)
o Fifth pathway will be displayed as a tag in the card.
o The cards will be displayed in reverse chronological order of the end date for the education and
professional training. The record with the newest end date is displayed first.
o All education/training records without an end date will be displayed in the end, in the reverse chronological
order of creation date. The last record created is displayed first.
o The portal will display the Training Type (Internship, Fellowship, Residency, and others in the Professional
Training tile.)

4.5. Specialties
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The Specialties section requests information regarding your specialties and certification information. Specialties and
Certifying Boards are based on the NUCC Grouping that you have selected in the Personal Information section.

The taxonomy codes corresponding to the specialties will help you confirm if you have selected the correct
specialty. The same details will also be displayed on your Data Summary.

Tips:
o If you need assistance, you can access the “FAQ” link that is displayed on the right-hand side of the screens.
o Use “Save and Go Back” or “Save & Continue” to page backward or forward within sections.
o It is important to click on the “Save” button or the “Save & Continue” button to save your information. Clicking
on the back and forward arrows via the left-hand navigation will also save your information.
o Click on “Add” to add additional specialties as necessary.
o If the “Import” button is active, information already entered by a practice manager is available for you to view
and import if you choose to do so.

Note: ALL providers are required to select a primary specialty. Suggested Primary Specialty is presented to
Providers who have not selected Primary Specialty (the provider has the ability to accept or edit the suggestion).

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 o You are now asked to respond to this question: Does your board certification have an expiration date?

o If you responded with a Yes, the Expiration Date field and the last Recertification date fields will be
required.

The specialties that are included in the drop-down list are collected from the National Uniform Claim Committee
(www.nucc.org). If you cannot locate your specialty in this list, select the specialty that is most appropriate for your
practice. If your specialty is not listed, you may enter it in the Other Interest” field, which is towards the bottom of
the “Specialty” page.
The subsections are listed below and may vary based on your practice state.
• Primary Specialty
• Secondary Specialty
• Additional Specialty
• Board Examination – dynamically displayed/hidden based on your entries
• Certifications – The system will ask if you have received any of the following certifications. Additional
information regarding each certification is provided below for your reference.
o CPR – Cardio-Pulmonary Resuscitation certification: Community level classes
concentrate on performing CPR on adults and older children. Some also include AED training,
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 which teaches how to use the electronic defibrillation unit on heart attack victims.
Professional level classes are designed for health care professionals, ski patrol, police,
firefighters, and emergency medical technicians. These classes teach all the skills previously
mentioned, as well as removal of airway obstructions for victims of all ages. Other skills are
also included in these classes, including inserting tubes to keep the airway open, using an
oxygen tank, artificial breathing apparatuses and techniques for performing two-person CPR.
o BLS – Basic Life Support Certification: Basic Life Support (BLS) certification is a relatively
short training course required of many health professionals to help revive, resuscitate, or
sustain a person who is experiencing cardiac arrest or respiratory failure of some sort. This
could include a drowning victim, heart attack or stroke patient, or any scenario where
breathing, or heartbeats have been compromised.
o ACLS – Advanced Cardiovascular Life Support Certification: ACLS is an acronym for
Advanced Cardiovascular Life Support. This certification is required of many healthcare
providers who will be interacting with patients. Like its name implies, ACLS is usually required
of more advanced medical professionals, as it does include some invasive procedures,
unlike Basic Life Support (BLS), which is required of almost all healthcare professionals.
o ALSO – Advanced Life Support in OB Certification: Advanced Life Support in Obstetrics
(ALSO®) is an evidence-based multidisciplinary training program that prepares maternity
health care providers to better manage obstetric emergencies when and wherever they occur.
ALSO’s evidence-based learning path bridges knowledge gaps and boosts skill sets using a
team-based approach, hands-on training, and mnemonics to reduce errors and save lives.
o Health Care Provider (Core)
o ATLS – Advanced Trauma Life Support Certification: Advanced Trauma Life
Support (ATLS) is a training program for medical providers (MD/DO/DPM/PA/NP/CO) in the
management of acute trauma cases, developed by the American College of Surgeons. Similar
programs exist for nurses (ATCN) and paramedics (PHTLS). The program has been adopted
worldwide in over 60 countries, sometimes under the name of Early Management of Severe
Trauma (EMST), especially outside North America. Its goal is to teach a simplified and
standardized approach to trauma patients. Originally designed for emergency situations where
only one doctor and one nurse are present, ATLS is now widely accepted as the standard of
care for initial assessment and treatment in trauma centers. The premise of the ATLS program
is to treat the greatest threat to life first. It also advocates that the lack of a definitive diagnosis
and a detailed history should not slow the application of indicated treatment for life-threatening
injury, with the most time-critical interventions performed early.
o NRP – Neonatal Resuscitation Program certification: NRP was developed and is
maintained by the American Academy of Pediatrics. This program focuses on basic
resuscitation skills for newly born infants.
o NALS – Neonatal Advanced Life Support certification: NALS training, administered by the
American Academy of Physician Assistants, delivers the same syllabus as NRP, has similar
flexibility in its format, and equips trainees with identical knowledge and skills.
o PALS – Pediatric Advanced Life Support Certification: The PALS Course is for healthcare
providers who respond to emergencies in infants and children. These include personnel in
emergency response, emergency medicine, intensive care and critical care units such as
physicians, nurses, paramedics and others who need a PALS course completion card for job
or other requirements.
• Anesthesia Permit
• Other Interests
• Professional Associations: A professional association or professional society is usually an organization
seeking to further a particular profession and the interests of individuals engaged in that profession.
This is the section where you specify which Medical Professional Associations and Societies you are
affiliated to. You can add more than one association to the list.

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4.6. Practice Locations
The Practice Locations section asks for detailed information regarding your practice location(s).
A Practice Location summary table will be displayed on the Practice Locations start page.
• The table contains the following column headers:
o Physician Group/Practice Name
o Tax ID – All practice location record should have one TAX ID number only.
o Address – displays the general address and phone number for the practice location; Address
1 and Address 2, City, State ZIP, Phone
o Actions – Edit (displayed as an eye-like icon), Search, Confirm (displayed as No Change to
Location button), and Archive
o Confirmation Date – directory data’s last confirmation date. All the complete active practice
location prior to (release date) will have the last attestation date as the confirmation date.
When a provider confirmed a location, the details of the location will be sent to the
Participating Organizations.
o Affiliation Description – the provider’s association to the location
o Location Type – it shows whether a location is provider managed or group managed

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A location highlighted in red indicates that a record has an error. A validation error message will be displayed at the
top of the page in the record to show what field should be fixed.

Providers can search or filter for a specific location from their list of practice locations. Search categories are based
on the information available on the location summary and are displayed alphabetically.
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If you have not indicated your affiliation with this location, the following will appear in red font in the Physician
Group/Practice Name column: “Response required.”

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If you have selected Office Type = Primary Practice for a practice location, that practice location will have a blue
indicator that says, “Primary Practice”. The practice location tagged as primary will appear first in the list.

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Last confirmed date is visible for each of the active location of the provider. There is also an indicator if a location is
coming due for confirmation (60+ days since their last confirmation) or if a location is past due for confirmation (90+
days since their last confirmation).

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If a provider attempts to confirm a location with no changes, a pop-up modal that includes the following information
will show to make sure that the details are the same:
o Practitioner Name (concatenated first, middle, last, suffix with spaces between)
o Practice Location Name
o Tax ID
o Appointment Phone Number (with extension if added)
o Practice Location Address
o Specialty at Location
o Practice Location Website
o Practice Location Email Address
o Appointment Scheduling Website

For locations that have pending suggested changes from third parties, a yellow flag that says Please Review:
Suggested Changes will appear on top. An eye icon indicates that a review is needed for that specific location.

Suggested Changes for Review are displayed at the top of the Practice Location edit screen.
o On the left-hand side, the provider will see the current values of the fields with suggested changes with the
last confirmed date of that location shown at the top. While on the right, the provider will see the suggested
changes with the most recent submit date of those data elements.
o If there are multiple qualifying suggested changes to the same data element, a tool tip is shown beside that
data element. If you hover the mouse, it will say: "We have found multiple values corresponding with this
location. Please indicate the correct one. “

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o Suggested Changes are presented in a radio button list which the provider may click to choose the correct
data. If none of the suggested details are to be chosen, the provider may click “None of These” from the list
and click the Accept Selected button to continue. If no suggested changes are selected, "Accept Selected"
button will be inactive.
o Changes that are accepted are saved to the location record, while those that are not selected will be
rejected.
o When changes are accepted, provider is shown a confirmation popup indicating so and has the option to
return to the Location Summary screen or continue editing the current location.
o A popup that lists the fields and values that were accepted and rejected will show.

o When changes are accepted, and there are no other required fixes on the location, the last confirmed date
will be updated.

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If a location has a suggested changes and the user attempts to Attest, this will appear in the Other Suggested Fixes
section.

A provider will not be able to confirm a location with an unattested specialty. If a provider has selected an
unattested specialty for a location, and clicks Save & Confirm, the last confirmed date will not be updated and it will
show a yellow dismissible banner at the top of the page with a message that says: "Changes saved, but
confirmation was not processed. Information you have updated on this location requires you to attest in order to
send these updates to health plans."

In the location summary page, a yellow indicator that says, “Attest to Confirm” will show on top of the location with
unattested specialty.

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If a provider updated their first name, middle name, last name, or suffix, and goes to the Practice Location summary
page, each location will have a flag of "Attest to Confirm", unless there is a Please Respond or a Duplicate flag on
the location, this will also disable the “No Changes on this Location” button.

Once the provider attests, confirmation date for that location will be updated and the Attest to Confirm banner will
disappear.

Tips:
o If you need assistance, you can access the “FAQ” link that is displayed on the right-hand side of the screens.
o Use “Save and Go Back” or “Save & Continue” to page backward or forward within sections.
o Save and Confirm will save the added/edited and at the same time confirms the location information if it has no
other error.
o It is important to click on the “Save” button or the “Save & Continue” button to save your information. Clicking
on the back and forward arrows via the left-hand navigation will also save your information.
o Select “Add” to enter information for a practice location.
o Select “Edit” to edit the information within a practice location. The Edit button is displayed as an eye-like icon
for locations with errors to be corrected and a pencil icon for completed locations.
o No Changes to the Location – click this button to confirm location without any changes. This button will be
active ONLY for complete practice location. If a practice location has an error, or is marked with the Attest to
Confirm banner, this button will be inactive.
o If the “Import” button is active, information already entered by a practice manager is available for you to view
and import if you choose to do so.

The list of practice locations in the Location Summary page is sorted based on the needed action. Below is the
hierarchy on how a list of locations is sorted based on the flag that is indicated on each location.
o Duplicate locations
o Please Respond
o Please Review: Suggested Changes
o Attest to Confirm
o Primary

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The Copy function has been added to the practice location section to make data entry as easy as possible. The
copy function will be available on each tab of the practice location. Providers can now copy each section from one
location to the other as long as the Tax ID is different from each practice location.
o Providers can copy information from active and archived locations.
o Providers can only copy location with the same address but different Tax ID.
o Providers can only copy tab-specific (Practice Details, Provider at the Location, and Services and Resources)
information from one location record to another.
o Copying practice location information from different state can be done but state specific information will be
asked as an additional required fix.
o Copied archived locations should not copy the Do you practice at this location? Or the Describe your affiliation
with this location question response. These fields are required to be completed by the provider.

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 o A Duplicate error message would prompt the provider if the information added has the same practice address
and Tax ID with the existing record.
o Providers must change the location address and/or the Tax ID to correct the error.

4.6.1 Practice Details

The Practice Details tab includes the following:
o Practice Location Name – the practice name that is referenced when a patient calls to make an
appointment
o Location Address – the exact address that patients use to find the practice and the address the plans often
publish in their directories; this includes the following: Street1, City, State, Zip Code, Country, County,
Practice Location E-mail Address, and Practice Location Website

ALL practice location addresses in your profile will undergo USPS address standardization. When you edit or add
an address, you will be asked to confirm whether the suggested address is correct.

Note: PO Box information will not be accepted on the practice location address fields. Valid characters for Practice
Name/City and Street 1 & 2 are limited to space, Aa-Zz, 0-9, and the following special characters # - . , ‘ /&.

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Providers will be allowed to indicate whether the practice location is virtual-only and that is never physically
accessible to patients.

If you select the checkbox indicating the practice location is virtual-only, the Location Address such as Street 1,
City, Zip Code, and Country will be removed retaining the State.

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If you have indicated that the location is virtual-only, you will be required to enter the Mailing Address on the
Services and Resources tab.

4.6.2 Duplicate Location Records

If you update a location record to an address and Tax ID Number similar to an existing location record, you will be
prompted with this message.

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You may remove one of these locations by clicking the Remove link. You will be prompted with a confirmation
message to proceed.

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You may also select the location record at the top and click Continue. The changes to the other location will not be
saved.

If you select the location record at the bottom and click Continue, you will be required to edit either the address or
the Tax ID Number.

If you add a new location record with the same address and Tax ID Number as an existing record, you will be
prompted with this message.

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You may select the location record at the top and click Continue. The new location record that you are trying to add
will not be saved.

If you select the other record and click Continue, you will be required to edit either the address or the Tax ID
Number to save the new record.
o Phone Numbers – the phone number that a patient uses to make an appointment. If the provider does not
take appointments, enter the main number for the location. This phone number will soon be validated using
the IPQualityScore (IPQS). Phone numbers identified as invalid/inactive will trigger a required fix.

Patients depend on the accuracy of provider directories when choosing a health plan and physicians. Inaccurate
directories pose significant challenges for patients, contributing to delays in care, limiting choices of providers and
masking problems with network adequacy.

In an ongoing effort to improve the accuracy of provider information listed within directories, CAQH will ask
providers to confirm that the phone number listed for each practice location is the primary method that patients may
use when scheduling an appointment. This phone number will soon be validated using IPQS. Phone numbers
identified as invalid/inactive will trigger a required fix. If you do NOT take appointments, confirm that the phone
number listed on the Practice Location section Office Phone Number field is the main number for the location.

• If you click the Edit link, you will be taken to the Practice Details screen for that Practice Location.
• If you click the Confirm link for a Practice Location, that line item will disappear from the Correct Errors
page.
• Business Identifiers – includes the Legal Business name, the Tax ID, and the Type of Tax ID
• Organization (Type 2) NPI

Note: All Type 2 NPIs will undergo a validation. A Type 2 NPI is validated against Type 2 NPIs in NPPES but is not
validating practice name against the registry. Validation failures will be displayed as a required fix.

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74
You may see the following errors on the Required Fixes page:
• This NPI number could not be found in the NPPES NPI registry. – This means that the Type 2 NPI that you
have entered is an invalid one. Please review for any possible typo error.
• This is an Individual (Type 1) NPI. – You may have entered an Individual NPI on the Group/Organization
NPI field. Please review the value that you have entered on the Group/Organization NPI field.
• Type of Practice
• Practice Office Hours
o Errors on the Practice Office Hours will appear on the Required Fixes page.
• If start time is entered, an end time will be required.
• The end time should be later than the start time.
o Users will also have the option to copy hours to another day by clicking the three vertical dots
beside the End Time.

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• Accessibility
o ADA Accessibility
o The Americans with Disabilities Act (ADA) ensures access to the built environment for people with
disabilities. The ADA Standards establish design requirements for the construction and alteration
of facilities subject to the law. These enforceable standards apply to places of public
accommodation, commercial facilities, and state and local government facilities.
• Handicapped Accessibility
• Public Transportation Accessibility
• Other Accessibility Services
• Disabled Accessibility
• Languages
o Languages spoken are displayed in alphabetical order

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Note: Upon Saving the Practice Details page of a practice location record, if the URL field for the Practice Location
Website has a value entered, it should be validated. The validation process should include the creation of a new
flag to softly identify if a URL is valid. Same validation will be applied to both the Practice Location Website and
Appointment Scheduling Website fields.

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4.6.3 Provider at the Location
The Provider at the Location tab displays the following details:
• Affiliation – describes the provider’s affiliation with the location; select your affiliation from the dropdown
o Which value to choose from the options?

Option 1: I see patients by appointment at least one day per week on a regular basis.
This option would be appropriate when:
• this is your primary practice;
• a patient can make an appointment to see you at this location;
• you practice regularly at this location; or
• you have been hired at this location and have a start date in the near future.

Option 2: I see patients by appointment at least one day per month, but less than one day per week on a regular
basis.
This option would be appropriate when:
• you work at this location on a seasonal or monthly basis;
• you have a regular routine where you see patients at this location infrequently but on a schedule; or
• you do not consider this your primary practice, but you routinely see patients at this location and patients can
even make an appointment.

Option 3: I see patients at this location, but not by appointment.

This option would be appropriate for:
• non-appointment providers who work at this location

Option 4: I cover or fill-in for colleagues within the same medical group on an as needed basis.
This option would be appropriate when:
• you see patients at this location on an on-call basis;
• you are part of a larger practice and usually practice at another location but might need to fill-in for a provider at
this one; or
• you serve in an urgent care capacity within a practice where you do not take appointments at the location, but
you deliver care.

Option 5: I read tests, perform imaging, or provide other services as my primary function at this location
This option would be appropriate when:
• you perform administrative tasks at this location but do not see patients; or
• you read tests for patients at this location but do not see patients.

Option 6: I no longer practice at this location

This option would be appropriate when:
• you left the practice all together and no longer practice at any locations affiliated with the practice; or
• you are still employed with the practice but have switched to a different location and will no longer submit
claims for services rendered at this location

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Note: If you choose “I no longer practice at this location.” A new date selector field “End date” will appear.
• The field format should be MM/DD/YYYY in the portal.
• The date entered on the “End Date” field must occur after the date entered in the field “Provider’s Start Date”.
• You should remember to update the Employment Information section of your profile with this information.

Option 7: I do not practice here, but the location is within the medical group with which I am employed
This option would be appropriate when:
You are employed by a large group and the practice manager for the group lists this location for you even though
you would never submit claims to this location.

Option 8: I never practiced here and have no affiliation with this location
This option would be appropriate when:
• The practice location was entered by mistake.

Option 9: This is a duplicate of an existing location.

• Network Denial – displays a checkbox for “I have closed my practice to at least one plan or program”
• Patients – The questions in this section pertain to your general activity and preferences at this location. They
are not specific to your activity in relation to any health plan. This is also where you can indicate the types of
patients accepted into the practice.
• Practice Limitations – ay restriction you have set on the gender or age of your patient population
o Gender Limitations – Female Only or Male Only
o Age Limitations – The value in the Age Maximum field must be greater than the value in the Age
Minimum field. Otherwise, it will appear on the Correct Errors page.
o Other Limitation

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For newly added locations, only 'Yes' responses will be displayed on the affiliation drop down on the Provider At
The Location page.

A tooltip was added next to the Primary Practice question on the page to inform only one “Yes” response is allowed.
“At least one Practice Location is required” is triggered when “Inpatient/Outpatient or Outpatient Only” or
“Military/Federal or Emergency Responder” practice settings is chosen.

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If multiple records have the Primary Practice Location selected as “Yes” an error will display on the summary page
and within the record.

When multiple Practice Locations exist but none are selected as the primary, the Correct Errors page will display:
“You are required to have one Primary Practice. Please edit the location you consider to be your primary, and
update the Provider at the Location tab.”

Specialty field in the location section supports the specialty confirmation for the No Surprises Act. This selection
should match the selected options from the Specialties page. The Subspecialty field is optional.

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Providers may enter their “Provider Directory Classification”, (PCP, Specialist, Specialist as PCP) so that
participating organizations can include this information in their directories.

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If the Provider Directory Classification is answered “None of the Above”, the Type of Services provided question will
show.

4.6.4 Services and Resources

The Services and Resources tab includes the following details:
• Telehealth – allows providers to indicate if they offer telehealth/telemedicine services for a practice location
o The system will require you to answer the question “Do you use a telehealth application or
platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?”
after clicking the checkbox for “I provider telehealth services”
• The question” Are you willing and able to support family caregivers?” is required ONLY for IL providers.
• User is also prompted to indicate the telehealth service type: Audio, Audio/Video, Secure Text Messaging,
Remote Monitoring, Store-and-Forward (multiselect). A description for every Telehealth Service Type will
show when you hover the mouse on the selected telehealth service type.

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 • Services
• Payment and Remittance
• Worker’s Compensation Information
• Colleagues
• Covering Colleagues Not at This Location
• Office Personnel
• Mailing Address

The following Mailing Address fields will be required for Behavioral Health & Social Service providers who have
indicated that the practice location is a virtual-only location: Street1, City, State, Zip Code, and Country.

• Phone Coverage
• Other Tax and Business Interests Information
• Other Location Information

Non- Illinois Providers

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Illinois Providers

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4.6.4.1 Payment and Remittance
To update the payment and remittance information:
1. Go to practice location and click the edit button of the location you want to update.
2. Click the Services and Resources tab.
3. Scroll down to the Payment and Remittance section.

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You may add a Payment and Remittance Contact by going to the Office Personnel section and clicking add.

A pop-up modal will show, select Payment and Remittance Contact for the question “What support does this person
provide*?”

Fill out the information about the contact that includes the name, address, and contact details then click on
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Continue or Save and Add Another.

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Note: If you have more than one contact for each contact type, you will have the ability to designate one contact as
the primary contact.

To designate a contact as the primary, click the link “Mark as Primary Contact?” and click the checkbox at the top of
the pop-up window.

If the provider has a single contact ONLY for each of the office personnel type (billing contact, office manager,
payment and remittance contact), the system will mark it as the primary.

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Email address is required for all of office manager record. This email address will undergo format validation. There
is also a help text explaining why this field is required.

Providers can indicate if the Directory Outreach Email should go to the practice manager by clicking the checkbox
beside the email address field. When a user checks this checkbox, the email address entered in the record shall be
added to the Directory Outreach email.

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When adding a colleague and/or office manager information, all of the required fields should be filled out completely
for it to be saved. The continue and save another button will remain disabled if any of the required field is
unanswered.

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For Providers whose Provider Type is either MD, DO, NP, or DMD with Inpatient/Outpatient or Outpatient Only as
the Practice Setting, each active practice location (where you answered Yes to the question: Do you practice at this
location?) should have a matching Primary Practice State or Practice State on the Personal Information section.
There will be an error for each active practice location that does not have a matching Practice State.

On the screenshot, the account has an active practice location in Colorado, but Colorado is not selected as a
Practice State in the Personal Information section. The Provider is required to either change the answer to the
question “Do you practice at this location?” from Yes to No for this practice location record or archive the practice
location record or add Colorado as a Practice State.
o The Update Practice Locations hyperlink in the error is a hyperlink to the Practice Locations Home Page.
To add a practice location to your profile, go to the Practice Location section of your CAQH Provider Data Portal
profile. Click the Add Location button.

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When adding a new practice location to your profile, you will be directed to the Practice Details page.

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The address will be standardized by SmartyStreets. You need to confirm that the suggested address is correct.
If you select the box for the address that you have just entered, you will be prompted with a message that states: By
selecting the un-standardized address, you acknowledge that Health Plans are likely to contact you directly to
confirm your address.

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If you select Continue, the address that you have entered will be displayed at the top of the page and you will be
directed to the Provider at the Location tab.

On the other hand, if you select the Standardized Address (Suggested) and click Continue, the standardized
address will be displayed at the top of the page and you will be directed to the Provider at the Location page.

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If you are adding a practice location with the same exact address and tax ID with an active practice location in your
profile, you will be prompted with a message that states: It looks like this location already exists in your profile.

If you are adding a practice location with the same exact address and tax ID with an existing record in your profile
but is in your archived locations, you will be prompted with a message that states: It looks like this location already
exists in your profile.

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4.6.5 Archiving a Location/s
The “Delete” functionality has been replaced with the “Archive” functionality. Archive a location where you do not
practice.

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The Archive link is disabled by default. To archive a location, select a location you wish to archive by clicking the
checkbox beside the practice name. Once a location is selected, the Archive Location with the number of location/s
button will be highlighted. You may then click it to archive the selected location/s.

You may archive one or more location/s in a single archive transaction.

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You will be prompted to select the reason for archiving a location/s. Choose from the dropdown for the reason. If
you selected more than one location and the reason to archive is the same, you may click the checkbox that says,
“This reason applies to all of the selected locations.”

Otherwise, you will need to choose a reason for each of the locations that will be archived.

If you select “I no longer practice at this location”, you will be required to enter the end date. Click Confirm Archive.

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If you are archiving a location for the first time, a section for Archived Locations will be displayed on the page.

Note: When you change your Practice Affiliation to indicate that you are not practicing at the location, that practice
location will be moved to the Archived Locations.

To view the archived location/s, click Show.

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The page will display the archived location/s.

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To hide the archived location/s, click Hide.

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4.6.6 Restoring an Archived Location/s
If you wish to restore the location, select a location to be restored and click on the Restore Location button. Only
provider-managed location could be restored from the list of the archived locations.

You will be prompted to select the reason for restoring the location. Select one from the options and click Confirm
Restore.

Provider can restore multiple archived locations.

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When a provider restores a single location, they must select the reason for restoring the location.

When a provider restores multiple locations at once, they must select the reason for restoring each location. Each
location name is shown with a selection drop down for the reason. When restoring multiple locations at once,
provider is able to indicate that the first selected reason applies to all of the selected locations.

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The location will now show as active. Restored location/s with errors will be flagged as a location that has a
required fix while complete locations that are restored will have an updated confirmation date (same date when the
practice was restored).

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4.6.7 Health Plan Participation
Providers who fall into these criteria will see a section for Health Participation on the Provider at the Location tab:
• Rostered by a Participating Organization/s for Provider Directory
• The rostering Participating Organization is authorized (see authorization page of your application)
• The following fields in the practice location record are populated:
o Physician Group/Practice Name
o State

Please indicate if you are in the contracting process or currently contracted with the Participating Organizations
listed below. If you are, please indicate your panel status for new patients.

The Health Plan Participation will appear next to the question “Is this your primary practice?”

If you select Yes, another required question will be displayed.

4.6.8 Help Patients Find You

Over time, some of the CAQH participating health plans may submit practice locations that they have on file for a
provider that needs to be reviewed. The CAQH Provider Data Portal will display any locations that do not appear to
be listed in the profile at the time they are submitted, these locations should be reviewed, and a provider may
accept or reject it depending on whether they practice there.

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When a provider clicks on the Review Now, the screen will show the details of the locations that the health plans
requested to be reviewed. The details include:
• Practice Name and Tax ID
• Practice Address
• Notes – this icon shows more information about the location i.e “This location has the same street
address of an existing location but has a unique suite/unit number.”, “This location has the same
address of an existing location but has a different Tax ID.”
• Days Elapsed – number of days since the health plan requested the practice location to be reviewed.

The provider needs to click the pencil icon to accept and edit the information of a location while the trash can icon is

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for rejecting the location. Locations that are not accepted or rejected within 90 days will be communicated to health
plans as No Response. Health plans use this information to decide which locations get published in their directories.

4.7. Hospital Affiliations

The Hospital Affiliations section requires you to:
• clarify admitting privileges status;
• explain why an admitting privilege is no longer active;
• declare admitting arrangements and non-admitting affiliations; and
• enter complete information for all hospitals you are affiliated with.

Inpatient Only providers are required to have at least one Hospital Affiliation. If your practice setting is Inpatient
Only and you have not entered any hospital affiliation records yet, an error will be displayed on the Required Fixes
page.

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The FAQ section has helpful tips on completing your Hospital Affiliations.

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Providers practicing in North Carolina will see an additional optional question which will be displayed below the
Non-Admitting Affiliation records.

4.7.1 Admitting Privileges

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To add an admitting privilege record for the first time, click the “Add button” beside the statement “Enter an
admitting privilege” You will be directed to a page where details of an admitting privilege record can be entered.
Required fields are indicated with a red asterisk. All other fields are optional.

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There is a self-help option to answer the commonly asked questions for the Admitting Privilege records page.

4.7.2 Admitting Arrangements

To add an admitting arrangement, record for the first time, click the “Add button” beside the statement “Enter an
admitting arrangement.” You will be directed to a page where details of an admitting arrangement record can be
entered. Required fields are indicated with a red asterisk. All other fields are optional.

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There is a self-help option to answer the commonly asked questions for the Admitting Arrangement records.

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4.7.3 Non-Admitting Affiliations
To add a non-admitting affiliation record for the first time, click the “Add button” beside the statement “Enter a non-
admitting affiliation” You will be directed to a page where details of a non-admitting affiliation record can be entered.
Required fields are indicated with a red asterisk. All other fields are optional.

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There is a self-help option to answer the commonly asked questions for the Non-Admitting Affiliation records page.

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A consolidated list of all the Hospital Affiliation records will be displayed in a summary table.
All admitting privilege records with “Is this your primary hospital?” = Yes are marked with a backwards chevron with
the white text “Primary Hospital” on the far left.

Within each record in the summary table is a gray “Remove” button which when clicked, will display the Delete pop-
up message.

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Tips:
o If you need assistance, you can access the “FAQ” link that is displayed on the right-hand side of the screens.
o Use “Save and Go Back” or “Save & Continue” to page backward or forward within sections.
o It is important to click on the “Save” button or the “Save & Continue” button to save your information. Clicking
on the back and forward arrows via the left-hand navigation will also save your information.
o Select “Add” to enter information for a hospital affiliation.
o Select “Edit” to edit the information within a hospital affiliation record.
o Select “Remove” to remove a hospital affiliation from your application. Please note that by selecting “Remove”,
all information entered for that hospital affiliation will be deleted.
o If the “Import” button is active, information already entered by a practice manager is available for you to view
and import if you choose to do so.

Providers with primary or secondary practice state of Illinois will have the Ambulatory Surgery Center as an
additional section in Hospital Affiliation.

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4.8. Credentialing Contact
The Credentialing Contact section asks for specific contact information for your credentialing contacts.
• You may provide multiple credentialing contacts based on their location by first indicating the “Location Type”,
e.g. practice location or hospital affiliation, and then by selecting from a drop-down list of your previously
entered practices or hospitals.
• You may also indicate the same credentialing contact for multiple locations by selecting the appropriate
locations from the drop-down menu in the “Location” field.

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Tips:
o If you need assistance, you can access the “FAQ” link that is displayed on the right-hand side of the screens.
o Use “Save and Go Back” or “Save & Continue” to page backward or forward within sections.
o It is important to click on the “Save” button or the “Save & Continue” button to save your information. Clicking
on the back and forward arrows via the left-hand navigation will also save your information.
o Select “Add” to enter information for a credentialing contact.
o If the “Import” button is active, information already entered by a practice manager is available for you to view
and import if you choose to do so.

4.9. Professional Liability Insurance

Here you are asked to supply a Professional Liability Insurance record, or an indication that you are covered by
FTCA or are self-insured/do not have insurance.

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By clicking the Add button, providers can access the CAQH insurance coverage form to add malpractice insurance
information.

1. Click “Add” to enter the details.

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• When adding a Professional Liability Insurance record, you are required to fill in the following fields:
• Policy Number – The following are the only special characters allowed in the Policy Number field:
o . period
o - hyphen
o / slash
o & ampersand
o () parenthesis
o # pound/hash
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If there are any other special characters in the Policy Number field, you will get a validation message:

“Please enter a valid policy number. Only .)(#/-& special characters are allowed.”

You can now copy and paste an insurance policy number into the Policy Number field.
o Current Effective Date – The Current Effective Date must not be greater than the Current Expiration Date.
Otherwise, an error will appear on the Required Fixes page.

o Current Expiration Date.

o Carrier Name
• Street 1 (pre-populated depending on the carrier name selected)
• City (pre-populated depending on the carrier name selected)
• Zip Code (pre-populated depending on the carrier name selected)
o Do you have unlimited coverage with this insurance carrier? (required only when you are practicing in
multiple states)
o Amount of coverage per occurrence
o Amount of coverage aggregate
o Individual Coverage
o Self-Insured – required only when you are practicing in any of these states: CAQH States, Oklahoma, and
Texas (NOT Colorado, Georgia, Massachusetts, Minnesota, North Carolina, Mississippi, Nevada, Oregon,
Washington, and West Virginia)

CAQH has added an optional field “Covered Practice Location”. Provides can now affiliate active practice locations
to insurance policies using this field. Click the checkbox of the applicable practice location/s.

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After you have entered all the required details, click “Save & Continue” found at the bottom of the page. You will be
prompted with a message reminding you to upload a copy of your Professional Liability Insurance Face Sheet or a
Certificate of Insurance document for the policy record that you have just entered.

Note: Please ensure that the following should match the details on your face sheet:
o Provider’s Name
o Current Expiration Date
o Policy Number entered

If these details on the PLI document do NOT match the information listed in your profile, the document will be
rejected.
o A consolidated preview list of all the Provider’s insurance policy records will be displayed on the page.

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The PLI section will be categorized by “Current” and “Expired” insurance policies.

Providers will see a tooltip for current insurance policies that are expected to expire before their next attestation
date.

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Tooltips are also visible for expired insurance policies that are older than 10 years.

Providers operating with FTCA exempt health centers can indicate FTCA coverage by selecting “I am covered by
FTCA”.

You can select the field “FTCA-Covered Practice Location(s) to indicate which of your active locations is associated
with an insurance policy.

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You can also select the same location for FTCA coverage and traditional malpractice insurance if a location is
FTCA exempt and covered by traditional malpractice insurance.

Additional details have been added to the page to help providers understand more about FTCA. A link to HRSA is
also available should you wish to learn more about FTCA and eligible entities.

Providers who have indicated that they are covered by FTCA will be required to upload a copy of the FTCA
document in the Documents section. Once the checkbox is selected and saved, a slot for the FTCA document will
be automatically created in the Documents section. You are required to upload a copy of your FTCA document in
this slot.

Providers without any traditional or non-traditional malpractice insurance are required to confirm their coverage
before they can proceed.

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By selecting “confirm” the options to add other malpractice insurance is deactivated.

Note: You are required to upload a confirmation letter on your professional letterhead stating lack of coverage or
providing further explanation. Please navigate to the Documents page to do so. This document will appear as
missing and required on the Documents section of your application.

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4.9.1 Renewing an Expired PLI Record
Renew an expired policy record for you to be able to upload a copy of the renewed policy. If you plan to send the
renewed PLI document through e-mail or US mail, it is critical that you first renew the expired PLI record in the
portal. Otherwise, your document will be rejected, and you will be asked to re-upload it in the portal using the
document slot for the renewed PLI record.
o When renewing an expired policy with an associated document in “Received”, “Approved”, or “Expired”
status, the “Edit” option will not work. Instead, click on the “Renew” button for the applicable policy and you
will be prompted to enter an updated Effective Date and Expiration Date. You will also be prompted to
upload an updated Insurance Face Sheet or Certificate of Insurance for the renewed policy. A missing PLI
document will appear on the Documents section for the renewed policy.

a. If you click the “Renew” button, you will be directed to a page where you need to enter the “Current
Effective Date” and “Current Expiration Date” of your renewed insurance policy.

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Note:
o The Current Effective Date should NOT be greater than the Current Expiration Date. You will be prompted
with a message “The Current Expiration Date must be after the Current Effective Date.”

o The expiration date entered here must match the expiration date listed on the insurance face sheet. If it
does not match, the insurance face sheet will be rejected from the CAQH Provider Data Portal.
b. Review the other details found on the page. Click Save and Continue after making the changes.

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Additional Information about PLI Documents/Letter of Self-Insurance
o The policy number will be added in the Document Name column next to the document name “Professional
Liability Insurance”. Example – Professional Liability Insurance – PL13483N.
o You will not see the “Replace” document action for any Professional Liability Insurance document type with a
status of “Approved” or “Expired”.
o You will only see the “Delete” action on Professional Liability Insurance documents with an “Expired” status.
o If you are self-insured, you will no longer see the Document Name “Letter of Self Insurance” from the document
dropdown list but you will now see the Document Name “Letter of Self Insurance/Explanation of No Insurance”.
o You will not see a document showing as “Missing” for any associated data record that has a “Current Expiration
Date” that is prior to today’s date.
o All “Professional Liability Insurance” documents with a status of “Expired” will appear as “Optional” if at least
one PLI document exists for a current PLI record with a status of “Missing”, “Received”, “Approved”, or “Failed”.

Throughout each step of completing the PLI section, help copy, and tooltips are available for help.

Providers can hover over each of the available options for additional information and instructions.

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The ‘self-insured’ question and answer will continue to show in the portal but on the Professional Liability Insurance
Record screen, right next to the question “Individual Coverage?” for Providers practicing in CAQH States,
Oklahoma, and Texas (NOT Colorado, Georgia, Massachusetts, Minnesota, North Carolina, Mississippi, Nevada,
Oregon, Washington, and West Virginia).

o If you have previously answered the “Self-Insured” question, your answer should remain for that self-
insured question.
o When you log in to your account after these changes have been implemented and navigate to the
Professional Liability Insurance section, you will no longer see the leading question “Are you covered under
a professional liability insurance policy?”

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 o If you previously answered “Yes” to “Self-Insured?”, the checkbox for “I am not insured will be ticked.
o If you previously entered a professional liability insurance policy, that record will be displayed in your
profile.

4.10. Employment Information

The Employment Information section asks for information regarding your employment history, including your current
and previous work information, any work history gaps, and any military employment information.

In order to create a seamless timeline of a provider’s work history reducing provider outreach and documentation
redundancies, the following Education and Professional Training types will create an associated Gap record in the
Employment History if the record includes both Start Date and End Date and is within the last ten years from the
current year.
o Internship
o Residency
o Fellowship
o Preceptorship
o Other Trainings
o Undergraduate
o Fifth Pathway
o Professional School

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An employment gap record will be created for each individual education and professional records in the last 10
years. The Start and End date for gap records will match the dates entered in the Professional Training and
Education record. The Gap Explanation field value will be pre-populated as “Academic/Training leave”.
The card will provide a link to the Education and Professional training record that the gap is sourced from. This will
allow providers to navigate to that section if they need to make changes.

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Tips:
o If you need assistance, you can access the “FAQ” link that is displayed on the right-hand side of the screens.
o Use “Save and Go Back” or “Save & Continue” to page backward or forward within sections.
o It is important to click on the “Save” button or the “Save & Continue” button to save your information. Clicking
on the back and forward arrows via the left-hand navigation will also save your information.
o Select “Add” to enter an employer and the related information.
o If the “Import” button is active, information already entered by a practice manager is available for you to view
and import if you choose to do so.
o If you have not yet started work at a location, enter your expected start date in the Start Date field.
o In general, a gap is any break in continuous, full-time employment for 3 months or longer.
o Some organizations may require a full work history beginning with your professional degree and the reporting of
all gaps in work history. Check with your credentialing organization.
o Instructions such as what details to include on the Employment Information section, how to handle employment
gaps, and any other work history-related details have been added to the page.
o You are required to enter at least one Employment Information record on the profile. To do this, click ‘Add’
button under New Employment Records.

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o Once you have added employment information to your profile, a preview of the record will be displayed on
the page with the following details: Practice/Employer Name, State Date, and End Date. If you have more
than one employment record, only the previous one/s will have the end date. Your current employment
record will be indicated with ‘Current Employment’.

o If there are any employment gap records, the CAQH Provider Data Portal will display a message” Add an
explanation for this gap” and a red marker “Please Respond”.’ The start and end date of the gap will also
be indicated. You are required to fill in all Employment Gaps before attestation. Click the Edit button to add
an explanation for the gap.

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o If the record is not a gap, the provider can click on the link to create an Employment Information record.

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o A separate screen will display the different fields for Employment Information Record and Employment Gap
Record when you click the ‘Add’ button under Manage Employment Information.
o A pop-up message will be displayed when a user enters more than one Current Employment Record.

o The screens shown below will be displayed when you click “Add” for a gap in employment.

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 o Click the dropdown to display the options.

Note: Providers practicing in Illinois, Georgia and Oklahoma will be required to enter a reason for unemployment
gaps longer than 30 days.

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Providers practicing in Oregon will be required to enter a reason for unemployment gaps longer than 60 days.

Providers practicing in Minnesota, West Virginia and North Carolina will be required to enter a reason for
unemployment gaps longer than 90 days.

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4.11. Professional References
The Professional References section asks for information regarding your references and their related contact
information.

Tips:
o If you need assistance, you can access the “FAQ” link that is displayed on the right-hand side of the screens.
o Use “Save and Go Back” or “Save & Continue” to page backward or forward within sections.
o It is important to click on the “Save” button or the “Save & Continue” button to save your information. Clicking
on the back and forward arrows via the left-hand navigation will also save your information.
o Select “Add” to enter a professional reference and the related information.

4.12. Disclosure
The Disclosure section includes all disclosure questions required for your practice states, including any state
specific disclosure questions as well as a disclosure of ownership section. Please answer the questions
accordingly.

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4.13. Authorize
The Authorize section allows you to indicate which healthcare organizations you would like to authorize release of
your profile information.

Review the information provided on the screen, select the applicable authorization, and agree to the authorization
release accordingly.
o You can indicate a “global” authorization, which allows access to your data profile to all healthcare
organizations that indicate to CAQH that you are an affiliated provider or am in the process of becoming an
affiliated provider. This is the recommended selection.
o You also can individually select organizations to allow access to your data profile by selecting “Only the
healthcare organizations that indicate I am an affiliated provider or am in the process of becoming an affiliated
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 provider, and I specify below”.
o In the “Other Organizations Authorization” section, you have the option to release a more limited set of your
data profile to healthcare organizations that you are not affiliated with.
• Organizations need data for providers who are not affiliated or participating in their network to pay out-of-
network claims. For example, if a health plan would like to verify a non-participating provider’s address
before they submit payment for the claim.
• In the “Other Organization Authorization” section, you have the option to either grant global authorization to
all health plans who indicate you are not affiliated or to select the individual plans who have indicated you
are not affiliated. By selecting the latter option, you will be able to view which health plans have asked to
view a limited set of your data and can grant access via line-item authorization. If preferred, you do not
need to authorize any organizations that you are not affiliated with.
o If you are interested in participating with additional health plans, you need to contact each health plan directly.
Once you are added to the health plan’s CAQH provider roster, the health plan will be listed on this
authorization screen.

4.13.1 Update Authorization

You can change or update your authorization selection at any time. Simply log into the CAQH Provider Data Portal
and select “Authorize” from the top navigation menu to make your change. Click “Save” for your changes to be
effective.

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5. Review Your Data
Once you have completed your data profile, select “Review and Attest” from the top navigation bar.

1. On the Review screen, there are three areas you can access to review your data. View Errors – Click here to address
any errors you need to fix within your data profile.
2. View Your Data Summary – Click here to view a PDF summary of your data profile.
3. Download Your State Application – Click here to generate a replica of any state specific application applicable to your
practice state(s).
Providers will only be allowed to upload documents after a successful attestation.

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5.1. Correct Errors
The “Correct Errors” screen will highlight any required or suggested fixes you may need to make to your data profile.

Tips:
o When you click on a required or suggested fix, the system will direct you back to the applicable section to make the
required changes.
o It is recommended that you also correct any suggested fixes to ensure your data profile is as complete and as
accurate as possible for health plans accessing your data.

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CAQH validates that the identification numbers you entered for DEA, NPI and TIN match the provider’s name associated
with that identification number. If applicable, you will be notified in the Suggested Fix section that the number you entered
does not belong to your provider’s name. You can choose to click on “Change” to correct this error or “Ignore” to keep the
data you entered the same. This step is optional, but CAQH strongly suggests you review any suggested fixes to ensure
your data profile is accurate.

5.2. View Documents

This section shows the information you uploaded in the portal and any missing documents needed to finalize your
application. This screen can also be accessed by clicking on “Documents” from the top navigation bar. Refer to Chapter 6
– Uploading Supporting Documentation from more information.

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5.3. View Your Data Summary
Click on “View Your Data Summary” from the “Review” screen to view a PDF summary of your application and validate that
the information entered is correct. Double-click the image to view your application and to enable the “Save” and “Print”
features.

5.4. Download Your State Application

You can click on “Download Your State Application” from the “Review Screen” to generate the CAQH standard form, or if
applicable a state specific form, of your information. Select a state for which you want the report generated, select the
“Include Supporting Documentation” checkbox if applicable, and double-click the image to view your state replica. You have
the option to print your application if desired. Note: the report will open in a PDF format.

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6. Uploading Supporting Documentation
6.1. Uploading Documents
To complete your data profile, you will need to upload into the CAQH Provider Data Portal any applicable supporting
documents.
Your profile must be complete, required errors must be fixed on the Correct Errors page and any account changes must
be attested first before you can upload documents.
The CAQH Provider Data Portal does not support faxing of supporting documents.
Here are the steps on uploading supporting documents on the Documents section:
1. Scan and save your document (if needed). Please make sure the document is in PDF, TIF, JPG or JPEG format for it
to be accepted into the system.
2. Log in to the CAQH Provider Data Portal using your username and password.
3. Click the Documents link on the top navigation menu to go the Documents section. Any missing documents will be
shown on this page.
4. Be sure to select the appropriate document name or document type when uploading documents. Each document must
be uploaded separately.
5. Click “Upload”. Click “Browse” to select a file for upload. Then, click “Upload”.
6. Your uploaded documents can be viewed on the “List of Documents” found on the upper portion of the same page.
7. Recently uploaded documents will show as “Received.” Once the document is reviewed by CAQH and accepted, the
status will change to “Approved”. All documents may be viewed regardless of the status.
8. You will have to click download to be able to view the document. You may also “Replace” an existing document, or to
“Delete” a document if necessary.

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Here are examples of supporting documents you may need to submit for your application:

o Drug Enforcement Administration (DEA) Certificate

o Controlled and Dangerous Substances (CDS) Certificate
o Malpractice insurance policy face sheet
o A signed Authorization, Attestation, and Release form.

6.2. Authorization, Attestation, and Release Form (AAR Form)

When you initially complete your data profile and attestation, a signed Release form is required for your data profile to be
complete.
To submit a Release form, you need to perform the following steps:
1. The Authorization, Attestation, and Release (AAR) Form applicable to your practice state is displayed in the
Documents section. The AAR will appear as “missing” if one is not presently attached to your profile.
i. For some states, it is one form, for others you may see a State Release and a State Authorization.
2. Sign the form (wet signature or electronic signature accepted) and indicate the date it was signed.
3. The signed AAR form must be submitted within 120 days from the signature date. If the AAR form’s signature date is
greater than 120 days, it will NOT be accepted by CAQH.
4. Upload the form to the CAQH Provider Data Portal.

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CAQH added some help content advising providers on how you can replace your application release document.

Note: that this kind of requests is only accommodated if there is a valid reason to replace the document such as a name
change, etc.

6.3. Failed Documents

CAQH will review all submitted supporting documents for accuracy within approximately 48 hours upon submission. A
tooltip will show the rejection notification which will include the specific reason why the document was not approved. The
document rejection notifications being sent via e-mail have also been revised to include the specific reason for rejection
and the next steps on how to correct the document. A document may fail for the following reasons:
1. Illegible – the document is not clear enough to be read.
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2. Not compliant – the document may be missing a date, may be missing a signature, or more than one document may
have been included within the same file.
3. Ineligible – the document submitted may have an expired date or does not correspond to the document type selected.
For example, if you upload a license to a “Professional Liability Insurance” document type, the document will fail. You
will need to upload the license using the “State License” document type.

Note: Signed supporting documents must be submitted within 120 days of the signature date. If a supporting document’s
signature date is greater than 120 days, it will not be accepted by CAQH.

6.3.1 North Carolina Providers

The CAQH Provider Data Portal requires different North Carolina State Release forms for each authorized Participating
Organization.
o If you have authorized individual organizations, you are required to upload a North Carolina State Release form
for every health organization that you have authorized.
o If you have selected global authorization, which authorizes any organization who adds you to their roster, a North
Carolina State Release form is required for every health organization that has added you to their roster.

o If you are new to the CAQH Provider Data Portal and practice in North Carolina, you will be required to upload a
separate, specific State Release form for each organization you have authorized. You must download the
specific form, sign it, and upload it to CAQH.

Note: First time attesting providers who practice in North Carolina will be required to upload each plan-specific
release forms before they can attest so that all of the plans that have rostered the provider will receive a signed AAR
for that plan. Providers in Initial Profile Complete, Re-attestation, or Expired Attestation statuses will be able to attest
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 without uploading additional plan-specific release forms if they have been added by another plan.

o If you have initially attested and have already uploaded at least one State Release form, your existing releases
will remain in the documents section. However, you will see new slots for “missing” State Release forms. There
will be one missing slot for each organization you have authorized.
o Click the ‘Download’ button corresponding to each of the missing State Release forms. The number of North
Carolina State Release forms available for download depends on the number of Pos who have added you to
their roster or the Pos you have individually authorized. These State Release forms will be pre-populated with the
PO name.
o Sign the State Release forms, indicate the date the forms were signed, and upload in the CAQH Provider Data
Portal Documents section by clicking the ‘Upload’ button corresponding to each of the missing documents.
o The ‘Missing’ status will disappear after you have uploaded these documents.
o Documents that require “Download” will have a status of “Missing” until a document is uploaded in that slot.
o State Release forms will be pre-populated with the names of authorized health organizations and will be
available for download from the Documents section.

o If the Document Type is CAQH AAR, the page will not show the actions links for Replace or Download for that
document if the status is Approved.
o You are required to upload ALL State Release forms even though the portal shows the remaining releases as
optional (only one State Release form is marked with a red asterisk).

6.3.2 AAR for Oklahoma Providers

Providers practicing in Oklahoma are now required to upload the CAQH Authorization, Attestation, and Release Form
(AAR Form) in addition to your Oklahoma Application Release. Only attested profiles with both Application Release and
Standard Authorization, Attestation and Release forms that are approved alongside with the other required documents
will be considered complete.

When you navigate to the Documents section of your application, you will see a missing CAQH Application Release.
Click the Download link to download a copy of the document.

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Sign the form and indicate the date it was signed.

Note: Signed AAR form must be submitted within 120 days from the signature date. If the AAR form’s signature date
is greater than 120 days, it will NOT be accepted by CAQH.

Upload the form to the CAQH Provider Data Portal by clicking the Upload link.

Note: The CAQH Provider Data Portal application will display the required documents based on your practice state,
your provider type, and any other details that you have entered on your profile. Other document types that don’t appear
as required in the Documents section of your profile, or in the drop down list, don’t need to be uploaded or submitted
to CAQH.

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7. Importing Data from the Practice Manager Module
If your practice has an office manager or clinic administrator who assists with gathering information for credentialing or
other administrative purposes for multiple providers, the CAQH Provider Data Portal for Practice Managers may facilitate
your data entry process. Data that is the same for multiple providers (e.g., clinic name, address and phone number) can
be entered once by a practice manager, rather than having to be entered repeatedly for each individual provider.

Once a practice manager enters this information for you into the CAQH Provider Data Portal for Practice Managers, the
practice manager will “export” the data, i.e. transfer the data, to your data profile. You will have the option to view this
data and choose to import the data if you desire.

The sections that a practice manager can export to a provider include:

1. Personal information
2. Professional IDs
3. Education
4. Professional training
5. Specialty
6. Credentialing contact
7. Practice location
8. Hospital affiliations
9. Professional liability insurance

At the top of each of these sections, you will see an “Import” button. If there is data available to you to import into your
data profile, this “Import” button will be active and available for you to select to review the data that was entered for you by
a practice manager. You can either choose to import the data as a new set of information or replace an existing set of
data within the applicable section.

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 7.1. Drag & Drop Functionality
When you click on “Import”, the “Select Information to Import” screen will present. You will use a “drag & drop”
functionality to import your data. Drag and drop is a pointing device gesture in which you can select the data to be
imported by “grabbing” it and dragging it into your data profile. Here is an example of professional liability information
entered by a practice manager that is available for import.

To add information to your data profile, click on the box containing the information and drag the box from the right to the
left side of the screen.
o By hovering over the box over information you already have in your data profile on the right side, you can overwrite
and replace the information. The system will confirm that this is what you would like to do.
o You can click on “Reject” if you do not wish to import the data into your data profile.

8. Completing Your Attestation

8.1. Attesting
Submitting your attestation is required to complete your data profile. This step allows you to make a final review of your
information and to attest to its accuracy. Click on “Review and Attest” from the top navigation bar to begin the process.

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If there are required fixes on your profile, you will be directed to this page. You need to correct all the errors before you
can complete the re-attestation. Click the View Errors button.

You will be directed to the page which shows the sections and the fields which you need to fill out or correct.

Once all the fields are filled out or corrected, the following screen will display. You are now ready to complete your re-
attestation. If you wish to review your data summary, you may click the link for “reviewed all information” or Click the View
Your Data Summary” found below the page. Then click Attest.
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If you have completed the attestation and there are no missing or expired documents on your account, you will be directed
to the screen below.

If the attestation was completed and you have yet to upload the required documents or there are expired documents that
require your attention, you will be directed to the screen below.

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A confirmation will be sent via email to you within approximately 48 hours after all documents have been received and
approved.

8.2. Re-Attesting
Re-attestation is required every 120 days (180 days for Illinois providers) in the CAQH Provider Data Portal to ensure your
data is maintained and accurate for health plan use. To complete your re-attestation, follow these steps:

If you have updates to make to your data profile, click on “Profile Data” from the top navigation bar and then the applicable
section to update any necessary information in your data profile.
If you need to upload any updated supporting documentation, click on “Documents” from the top navigation bar to upload
your documentation.
Once you have updated any applicable information or supporting documentation, click on “Review and Attest” from the top
navigation bar to begin the re-attestation process.

On the Review screen, you can view if any required fixes or supporting documents need attention.

Note: If the PLI and/or State License have expired, you will be prompted to update the expiration date and other relevant
details on your profile before you can attest. Once these steps are completed you will be able to attest.

Correct all the required fields by clicking View errors.

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Once all the fields are filled out or corrected, the following screen will display. You are now ready to complete your re-
attestation. If you wish to review your data summary, you may click the link for “reviewed all information” or Click the View
Your Data Summary” found below the page. Then click Attest.

The “Attestation Completed” screen will then display.

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A confirmation will be sent via email to you within approximately 48 hours after all documents have been received and
approved.

8.3. Re-attestation Reminder Emails

Re-attestation is required every 120 days (180 days for Illinois providers) in the CAQH Provider Data Portal to ensure your
data is maintained and accurate for health plan use. CAQH will email you to remind you when you are due for re-
attestation. System automated generated emails will be sent to your primary method of contact email, and if on file the
Additional Email Contacts, at the following intervals (message frequency and timing differs for Illinois providers):
o 15 days prior to expiration
o 10 days prior to expiration
o days prior to expiration

If no re-attestation has occurred, a provider will be put in “Expired” status on the day after the re-attestation was
due. Providers in expired status will receive the following notices:
Day after provider is placed in expired status
o 14 days after expired
o 28 days after expired
o 42 days after expired – final notice

Verify your primary method of contact email on the Personal Information section. It is important to keep this email
accurate and current so that you receive these important messages. You also can enter two additional email addresses in
this same section that will be copied on the system generated messages.

8.4. Resources and Training

This link provides more information regarding the CAQH Provider Data Portal for Providers and will have three options in
the dropdown:
o Resources: Upon clicking this, it takes the users to PR Resources page.
o Get Trained: Upon clicking this, it takes the users to our free, on-demand training library.
o Contact Us: Upon clicking this, it takes the users to PR Contact CAQH page.

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Appendix
Provider Status
Provider statuses are defined below and are system populated or manually changed by the CAQH Provider Data
Portal Support Center based on the status of your data profile:

Status Definition
New Provider Provider has been entered into system but has not been sent a registration kit.
Initial Outreach Provider has been sent outreach but has not yet registered.
Undeliverable Unable to outreach to provider due to lack of valid information. For example,
invalid email address.
Alternate Outreach Provider has been messaged at a secondary location after attempts are made to
primary office location.
First Provider Contact Provider has called or logged into the CAQH Provider Data Portal.
Profile Data Submitted Provider has progressed through the CAQH Provider Data Portal and “attested”.
Still waiting for supporting documents. Also, may be referenced as “Application
Data Submitted”.
Initial Profile Complete Information has been attested to and supporting documents received. Also, may
be referenced as “Initial Application Complete”.
Re-Attestation After the provider has reached initial application complete, and the provider is
keeping information current and “attesting”.
Expired Attestation After attestation is greater than 120 days old.
Opt out Provider has asked to be removed from the CAQH database.
Provider Retired Solutions Center is contacted that provider has retired from practice.
Provider Deceased Solutions Center is notified that provider is deceased.

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Training Information
PARTICIPATING ORGANIZATIONS
Users may access our free, on-demand training center for training on CAQH solutions. To enroll in the learning center:
1. Log in to https://proview.caqh.org/PO.
2. Scroll to the bottom of the page and click on “Get Trained.”
3. You will be routed to the training library for participating organizations and will be able to register.
PRACTITIONERS, GROUPS, PRACTICE MANAGERS
Users may access our free, on-demand training center for training on CAQH solutions. To enroll in the learning center:
1. Log in to your portal.
a. Practitioners log in to https://proview.caqh.org/PR.
b. Groups log in to https://proview.caqh.org/EPM.
c. Practice Managers log in to https://proview.caqh.org/PM.
2. Scroll to the bottom of the page and click on “Get Trained.”
3. You will be routed to the training library for practitioners, groups, and practice managers and will be able to
register.

Solutions Center Information

PARTICIPATING ORGANIZATIONS
o Chat with us by logging in to: https://proview.caqh.org/PO.
▪ Chat Hours: Monday – Friday: 8:00 AM - 5:00 PM (ET).
o Call us at 888-600-9802.
▪ Phone Hours: Monday – Friday: 8:00 AM - 5:00 PM (ET).
PRACTITIONERS, GROUPS, PRACTICE MANAGERS
o Log in to your portal to Chat with us.
▪ Chat Hours: Monday – Friday: 8:00 AM – 6:30 PM (ET).
▪ Practitioners log in to https://proview.caqh.org/PR.
▪ Practice Managers log in to https://proview.caqh.org/PM.
▪ Groups chat coming soon.
o Call us at 888-599-1771.
▪ Phone Hours: Monday – Friday: 8:00 AM - 8:00 PM (ET).

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Revision Log
Version Updates

Version 1 Original

Version 1.1 • Updated System Security section.

• Updated Chapter 5 – Review Your Data to reflect current print
screens of Review tab
• Updated Chapter 8 – Completing Your Attestation to reflect current
print screens of Attest tab
• Updated Appendix – Provider Status table to reflect accurate names
for provider status, specifically “Application Problem”, “Application
Data Submitted”, and “Initial Application Complete”.
Version 2 • Updated System Security section
• Updated Chapter 6 – Uploading Supporting Documentation. Added
information regarding failed supporting documents.
• Updated Chapter 8 – Completing Your Attestation. Added
information regarding when re-attestation reminder emails are
distributed.
• Updated sections within Chapter 4 – Completing Your Profile
Information.
• Clarified that the Disclosure of Ownership questions must be
downloaded, signed, and uploaded for organizations to access
information in replica applications.
• Clarified that primary email and PMOC CC1 and PMOC CC2 are the
emails that are sent the automated system generated emails.
• Added additional information regarding authorizing organizations
with which a provider does not participate.
• Added reference to “Save” button – users can click on the “Save”
button to save their information entered on a screen.

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Version 3 • Updated screenshots for all pages/sections to show enhancements
on the CAQH Provider Data Portal
• Added details on uploading supporting documents
• Added details on uploading North Carolina State Release forms
• Added some screenshots on the Documents section
• Added a section for the Progress Bar
Updated the names of some of the buttons and links
Version 4 • Added a note on page 43 that states: The signature on the initial
AAR form should be a wet signature. Stamped or electronic
signatures will NOT be accepted.
• Added some more details about Activity Log on page 14.
• Added a note that ALL documents may now be viewed regardless
of the status.
Version 5 Updated the following pages to add some more tips and instructions:
Professional IDs, Education, Specialties, Practice Locations, Hospital
Affiliations, Employment Information
Version 6 Updated the following pages: Uploading documents (AAR documents),
Practice Locations Address Standardization, Professional Liability
Insurance
Version 7 • Updated Personal Information and Practice Location section to add
details about NPI validation
• Updated Practice Location to add details about validating all practice
location addresses
Version 8 Updated Practice Location with the recent changes

Version 9 Updated Chapter 3 (Homepage) and Chapter 4 (Practice Locations

section)
Version 10 Updated Practice Location, Personal Information, and Re-attestation
section to incorporate recent changes in the system

Version 11 Updated Hospital Affiliations section

Version 12 • Updated the screenshots to reflect changes related to the ADA

providers
• Updates the screenshots to reflect the merged Review and Attest
button
• Added the process for submitting CAQH AAR document for
providers practicing in Oklahoma
• Updated Practice Locations section
• Added the new re-attestation process
Version 13 Updated the process for retrieving username and resetting the password
or primary e-mail address

Version 14 • Updated the screenshot to reflect Authorize option on the top

navigation pane
• Added the new Authorize option on the top navigation page and the
new authorization setting
Version 15 Updated Chapter 2 to indicate that providers will be redirected to the
Reset Password page after 5 failed log-in attempts; updated Chapter 6
to reflect the changes to the North Carolina plan-specific AAR
documents

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Version 16 Added details on how Type 1 and Type 2 NPIs are validated

Version 17 Added details on the changes in editing SSN and DOB

Version 18 Added details in the changes in the license number field

Version 19 Updated Practice Locations section, Specialties, and Employment

information section to incorporate recent changes in the system

Version 20 Updated Chapter 4 to indicate the Individual NPI validation

Version 21 Updated the following sections: Personal Information, Education,

Specialties, Professional Liability Insurance, and Documents

Version 22 Added details on the enhanced self-registration page and the Check for
CAQH ID feature, updated Provider Status Appendix

Version 23 Updated the following sections: Professional IDs, Education and

Professional Training, Practice Locations, Hospital Affiliations,
Professional Liability Insurance, Employment Information, and
Documents section
Version 24 Updated the following sections: Home Page Navigation, Practice
Locations, and Documents

Version 25 • Added details about the Copy Function and Office Hours Validation
on the Practice Location section.
• Added details on the new CLIA Certificate Document Name
Version 26 Added the recent changes on Gender Dysphoria, AZ CDS, and the
Maintenance and Deployment Schedule on the Provider Data Portal
login page
Version 27 • Updated the following sections with enhancement details:
Homepage; Education and Professional Training; Employment
Information; and Practice Locations
• Updated the screenshots in almost all sections to show new header
design and completion indicator for each of the sections
Version 28 Updated Personal Information section to add the NPI Type 1 validation
for providers who have previously indicated that they do not have a Type
1 NPI
Version 29 Added the validation message for Policy Numbers

Version 30 Updated Practice Locations section to indicate that the area codes for
the Appointment Phone Numbers will now be validated

Version 31 • Added a screenshot for the new deployment schedule

• Added demographics information
• Updated screenshot for specialties to show taxonomy codes
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 • Added instructions on duplicate location records
• Added new affiliation option (I see patients at this location, but not
by appointment)
• Removed Other affiliation option
• Updated the language for Affiliation Option 5 (I read tests, perform
imaging, or provide other services as my primary function at this
location)
• Added details on copying and pasting an insurance policy number
• Updated screenshots for the successful re-attestation page
Version 32 • Moved Internet Explorer from the “fully supported” list to the
“compatible” list.
• Updated screenshots for the DEA alternate prescribing methods
• Updated screenshots to remove the duplicate reason for archiving
locations
• Updated screenshots to show the labels added to the education and
training gap records
• Updated screenshots and added details on designating primary
contact for contact types with more than one contact
Version 33 • Updated the screenshot to show the back to list button added to the
education and professional training sections
• Updated screenshots of the review and attest page
• Added the new field Provider Directory Classification
• Updated Alternate Prescriber Field to show that it is a required field
• Updated screenshot of skills information to show PANS and
PANDAS as an additional option
• Added the new Resources and Trainings link
Version 34 • Updated practice location section to show confirmation date
• Updated the Get Trained link in the provider portal
• Make specialty section required for all providers
• Telehealth Data Capture enhancement to include inclusion of a
family caregiver in a telehealth visit
• Make type 2 NPI required
• Added screenshot enforcing required fields before closing the modal
• Make email address required for all office managers
• Updated ADA registration link
• Added screenshot to show practice website validation
Version 35 • Updated Solutions Center Operation Hours
• Updated DOB instruction
• Added information in Hospital Affiliation for IL providers
Version 36 • Updated NPI Type 2 Validation
• Add Telehealth Modality Descriptions
• Enhancement on the OK profiles being complete even if one of the
Application Release or AAR is missing
Version 37 • Updated Practice Location to reflect new UI
• Added the NSA data pop up modal when there is an attempt to
confirm location without changes
• Updated NPI Type 2 field screenshot to reflect ability to add; updated
error message for invalid Type 2 NPIs
Version 38 Removed notes that states: The signature on the initial AAR form should
be a wet signature. Stamped or electronic signatures will NOT be
accepted.
Version 39 Updated information on location confirmation for unattested specialty.

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Version 40 • Added information about suggested changes in the practice location
• Put a note for location appointment phone number validation
• Updated information on location confirmation for unattested provider
name change.
Version 41 • Change the Special Experience, Skills and Training Section
screenshot
• Updated Provider at the Location information for newly added
location
Version 42 • Updated for CAQH Rebranding.

Version 43 • Help Desk Rebranding

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