The Ultimate Guide for Providers: Creating a CAQH Profile and Verifying Information for Private Payers
If you are a healthcare provider, your CAQH ProView profile is your gateway to joining insurance panels and billing payers efficiently. CAQH (Council for Affordable Quality Healthcare) is a universal database used by most commercial insurance companies in the U.S. to streamline credentialing.
Creating and maintaining an accurate CAQH account is essential. Private payers rely on your CAQH data to verify your licenses, certifications, liability coverage, practice addresses, and other credentials. Inaccuracies or incomplete profiles can delay credentialing, prevent reimbursement, and even result in termination from payer networks.
This post is a comprehensive guide to:
Creating your CAQH account
Completing your provider profile
Submitting required documents
Verifying information with private payers
Avoiding common errors
Maintaining your profile for ongoing compliance
Step 1: Creating Your CAQH Account
1.1 Registering
Go to www.caqh.org/proview
Click “Register”
Select your provider type (physician, nurse practitioner, therapist, etc.)
Enter your NPI (National Provider Identifier), full legal name, date of birth, and practice location
Create a secure username and password
You will receive an email verification link. Click to confirm registration
1.2 Tips for Registration
Make sure your NPI matches exactly with your legal name and license
Use a professional email (not a personal Gmail or Yahoo) that you check regularly
If you are a provider in multiple states, ensure all addresses and license numbers are entered correctly at registration
Step 2: Completing Your CAQH Profile
2.1 Entering Demographics
Confirm personal information: name, date of birth, NPI, SSN (if requested), gender, and contact info
Add all practice locations and phone numbers
Enter the primary location first; this is the address payers will use for correspondence
2.2 Licensing Information
Enter all state licenses, license numbers, and expiration dates
Include DEA registration numbers if applicable
Add specialty certifications, board certifications, and hospital privileges
2.3 Professional Liability
Enter all malpractice carriers
Provide policy numbers, limits, and expiration dates
Upload declarations or insurance verification letters if required
2.4 Education and Training
Enter all medical school, residency, fellowship, and training programs
Include start and end dates
Ensure the information matches primary-source verification documents
2.5 Work History
List all relevant past employment
Include practice names, addresses, start and end dates
Include any gaps in employment and provide explanations if required
2.6 Disclosure Questions
Answer all malpractice claims, sanctions, exclusions, and felony questions
Be honest: discrepancies between CAQH and payer verification can delay approval
Step 2.7: Adding Multiple Practices or Locations
For providers working in more than one practice or location, CAQH allows you to link multiple practice sites to a single provider profile. This is essential for credentialing with private payers who may require verification for each location.
How to Add Multiple Practices
Navigate to “Practice Locations” in your CAQH profile.
Click “Add a New Location”.
Enter:
Practice name
Address
Phone number
NPI (if location has a separate group NPI)
Taxonomy code specific to the services provided at that location
Indicate whether this is your primary location or a secondary location.
Repeat for each additional practice site.
Best Practices for Multiple Locations
Ensure accuracy: Each location must match the information payers have on file, or verification will be delayed.
Use unique contact emails if needed: Some payers may send correspondence to each practice separately.
Update insurance and liability info for each location: Certain policies or coverage limits may differ by location.
Coordinate taxonomy codes: If the services differ by location (e.g., primary care vs telehealth), ensure the correct codes are listed.
Maintain a master document library: Keep scanned licenses, malpractice, and DEA documents accessible for each location to avoid delays.
Why This Matters
Adding multiple practices correctly ensures that:
Payers verify each location quickly
Claims from each site are processed correctly
Re-credentialing is smooth and consistent across all practices
Step 3: Submitting Required Documents
Most private payers require supporting documentation uploaded to CAQH:
State licenses
DEA certificates
Board certifications
Malpractice insurance declarations
Hospital privileges letters
CV or resume
Tips:
Scan documents clearly, avoid blurry or cropped images
Ensure document names match what is requested (e.g., “DEA_Certificate.pdf”)
Keep digital copies organized for quick updates
Step 4: Attesting to Your Information
Once your profile is complete:
Click “Attest”
Review all entries for accuracy
Attest electronically by typing your name
Submit your profile
Note: Payers will only accept CAQH attestation within the last 180 days. If your profile is older, you must re-attest.
Step 5: Verifying Information with Private Payers
After your CAQH profile is complete, verification is required for each payer.
5.1 Initial Verification
Private payers use CAQH to pre-fill credentialing forms
You may be contacted for missing documents or clarifications
Monitor email and portal messages carefully
5.2 Tips for Private Payer Verification
Confirm your CAQH NPI is linked to the payer’s system
Ensure all specialties, taxonomy codes, and practice addresses match payer expectations
Respond to document requests promptly
Track your credentialing checklist for each payer separately
5.3 Common Issues During Verification
Outdated licenses or DEA numbers
Missing malpractice coverage verification
Incorrect taxonomy codes
Name mismatches across CAQH, NPI, and payer systems
Fixing these issues proactively saves weeks of delays.
Step 6: Maintaining Your CAQH Profile
Credentialing is ongoing. To avoid re-credentialing delays:
Re-attest every 180 days
Update licenses immediately upon renewal
Upload new malpractice declarations annually
Keep DEA, hospital privileges, and address information current
Monitor payer portals for discrepancies
Proactive maintenance ensures smooth re-credentialing and prevents claims denial.
Step 7: Insider Tips from Credentialing Experts
Use one central email for all CAQH communications
Keep a document library with PDFs of licenses, DEA, CV, and insurance declarations
Double-check state-specific telehealth regulations if practicing across multiple states
Link your NPI correctly across CAQH and payer portals
Audit your profile regularly for accuracy
Conclusion
Creating a CAQH account and verifying information for private payers is foundational for any provider. While the steps may seem straightforward, the nuances in licensing, documentation, and verification processes can be complex.
Providers who take the time to complete their profiles accurately, submit all documents properly, and maintain their CAQH account avoid delays, rejections, and compliance issues. For clinics, groups, and multi-state practices, having a structured process or a partner like Rivon Health can save months of credentialing time and prevent revenue loss.
Mastering CAQH is not just a box to check—it’s the key to becoming fully credentialed and operational with private payers across the U.S.
Save Time and Avoid Credentialing Headaches with Rivon Health
While creating and maintaining a CAQH profile may seem straightforward, the reality is that it can be extremely time-consuming and prone to errors—especially for providers managing multiple locations, multiple payers, or complex credentials. Missed deadlines, incorrect documentation, or small errors can lead to delayed credentialing, denied claims, and lost revenue. That’s where Rivon Health comes in. Our team of credentialing experts handles CAQH setup, profile maintenance, document submission, and private payer verification on your behalf, ensuring your information is accurate, up-to-date, and fully compliant. By partnering with Rivon, providers can save weeks or even months of administrative work, reduce risk, and focus on what matters most: patient care and practice growth.