Top 7 CAQH Mistakes That Delay Credentialing and How to Fix Them

Credentialing is a crucial process for healthcare providers, especially for those just starting their practices. Whether you’re a mental health professional, OB/GYN, optometrist, or another healthcare provider, getting credentialed with insurance companies through CAQH (Council for Affordable Quality Healthcare) is vital for ensuring you can receive claim reimbursements and grow your practice. 

However, there are several common mistakes that healthcare providers often make when navigating the credentialing process; mistakes that can cause delays, extra work, and even lost income. In this post, we’ll take a closer look at the top 7 CAQH mistakes and how to fix them so that you can get back to what you do best: providing exceptional care for your patients.

1. Incomplete or Outdated/Expired CAQH Profiles

One of the most common mistakes healthcare providers make is leaving their CAQH profiles incomplete or not updating them regularly. An incomplete or outdated profile can cause delays because insurers rely on the data you provide to verify your qualifications and allow you to participate in their networks. Missing or incorrect information can result in credentialing delays or outright claim denials. Claim denials mean no money! 

How to Fix It:

• Review your profile regularly. Make it a habit to check your CAQH profile every 3 months to ensure all your information is accurate and up to date.

• Fill out every section. Even if it feels tedious, ensuring that every field is complete helps avoid delays. This includes licenses, certifications, education, and employment history.

• Cross-check your details. Ensure that the information you input matches what’s on your official documents, such as your license or insurance certificates.

If maintaining your CAQH profile every 3 months sounds like too much admin work on your plate, reach out to HMV Solutions today and let's take care of it for you! Let’s chat!

2. Missing Supporting Documents

CAQH requires that you submit various supporting documents to verify your qualifications, such as your medical license, proof of malpractice insurance, and board certifications. Not submitting the required documents or failing to upload them correctly can result in your credentialing application being put on hold.

How to Fix It:

• Double check document requirements. Before submitting your CAQH profile, go through the document checklist carefully. Ensure that all required documents are attached and up to date.

• Ensure quality uploads. Submit high-quality scans of your documents to avoid any legibility issues.

• Stay organized. Keep all your credentialing documents in one place so they’re easy to find and update when necessary.

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3. Neglecting Attestation Deadlines

Attestation is the process of confirming that the information in your CAQH profile is accurate. CAQH requires providers to attest to their profiles every 120 days. Neglecting to attest on time can result in your profile becoming inactive, which could delay your credentialing process and prevent you from being reimbursed for services rendered.

How to Fix It:

• Set reminders. Mark your calendar every 4 months to remind yourself to log in to CAQH and attest.

• Automate where possible. Use a task management system or set email reminders to ensure you never miss an attestation deadline.

• Stay proactive. Don’t wait until the last minute! Attest to your profile as soon as possible to avoid unnecessary delays.

If you are looking for an easy way to track this information check out the HMV Solutions Healthcare Provider Credentialing Information Tracker! An organized, easy-to-use spreadsheet designed for healthcare providers, new graduates, and administrative professionals to track and manage credentialing details in one central place.

4. Inconsistent Information Across Platforms

It’s easy to overlook small inconsistencies, such as a slight variation in your name or employment dates between CAQH and your state licensing board or insurance companies. These discrepancies can delay your credentialing process because insurers may question the accuracy of your information.

How to Fix It:

• Double check everything. Review your CAQH profile against your license, employment records, and insurance information to ensure all the details match exactly.

• Consistency is key. Whether it’s your professional credentials, name, or business address, make sure it’s uniform across all platforms and documents.

5. Ignoring Payer-Specific Requirements

Different insurance companies may have additional requirements when it comes to credentialing. These can include specific documents, forms, or processes that are unique to each payer. Failing to follow these requirements can lead to delays or rejections.

How to Fix It:

• Research payer specific requirements. Before submitting your CAQH application, review each payer’s credentialing requirements carefully.

• Create a checklist. Maintain a list of requirements for each insurer you plan to work with, so you can cross reference and make sure everything is in order.

• Ask for help. If you’re unsure about a payer’s requirements, don’t hesitate to call their credentialing or provider relations department for clarification.

6. Slow Responses to Verification Requests

When CAQH or insurance companies request verification, whether it’s to confirm your employment history, education, or training, it’s crucial to respond promptly. Delays in responding to these verification requests can hold up your entire credentialing process.

How to Fix It:

• Respond promptly. As soon as you receive a verification request, respond within 24 to 48 hours to keep the process moving forward.

• Stay in touch with references. Ensure that your references, employers, and educational institutions know they may be contacted for verification, and keep their contact details up to date.

• Track requests. Keep a log of any verification requests you’ve submitted or received to ensure nothing falls through the cracks.

  
  

7. Underestimating the Time Commitment

Credentialing is not a quick process; it takes time. For new practitioners, especially, the process can be overwhelming. Waiting until the last minute to begin the credentialing process can result in delays that affect your ability to see patients or bill insurers.

How to Fix It:

• Start early. Begin your credentialing process at least 4 to 6 months before you want to start seeing patients. This allows enough time for any unexpected delays.

• Plan ahead. Expect the process to take several months, and be realistic about the time and effort involved.

• Outsource if needed. If you’re too busy managing your practice, consider hiring a credentialing service to help expedite the process.

If you are ready to outsource, reach out to HMV Solutions today and let's take care of all your credentialing needs for you! Let’s chat!

What This Means For You

Credentialing doesn’t have to be a roadblock to your practice’s growth. By being proactive, staying organized, and avoiding these common mistakes, you can streamline the process and get yourself in network with the right insurers. As a healthcare provider, your time is valuable, and minimizing credentialing delays ensures that you can focus on what truly matters which is providing excellent care to your patients.

At HMV Solutions, we understand the unique challenges you face as a healthcare provider and entrepreneur. We’re here to help you navigate the credentialing process, as well as support your practice in other administrative areas. Book a free consultation to learn more about how we can support your credentialing journey. I look forward to supporting you!