Humana Contracts with CAQH
for Credentialing Services

Humana is now participating in the Council for Affordable Quality Healthcare (CAQH) Universal Credentialing DataSource initiative, an online service to help physicians more easily and cost-effectively provide required credentialing information to health care organizations and health plans.

More than 140,000 physicians nationwide have registered with CAQH for the service, with an average of 1,500 signing up weekly. CAQH DataSource is currently available for Doctors of Medicine (M.D.s) and Doctors of Osteopathy (D.O.s). It will be rolled out to allied providers in the future.

Humana network and ChoiceCare Network physicians can now utilize CAQH’s Universal Credentialing DataSource for recredentialing instead of completing a Humana-specific credentialing application. New physicians joining the network will also be able to use CAQH for the initial credentialing process.

This change offers several benefits to physicians. Universal Credentialing DataSource provides a fast and easy way for physicians to securely submit their credentialing information to multiple health plans and networks by entering their information just one time. Application data can be submitted anytime through the convenience of the Internet or by fax.

This simplifies the credentialing effort, reduces paperwork and saves time for busy physicians and office staff members. Best of all, this service is provided at no cost to participating providers.

How it works
CAQH provides each physician with a CAQH identification number, which allows access to the online application system. Once in the system, the physician creates a user name and confidential password. With this user name and confidential password, the physician can begin to complete the application online. The online application uses an interview-style process, which prompts the physician to answer questions and edits for errors and omissions.

The process incorporates the standard application data set and also, where appropriate, accounts for any additional credentialing information required by states with specific application mandates. Before the completed application is available to any participating organization, the physician must authorize release of the data. All organizations that have included the provider on their rosters will appear on the authorization screen for the physician to review and authorize.

The applications are stored in an online database and are always available to the physician to update, review or print. The applications are also available to participating and authorized health plans to view, search and retrieve credentialing information on providers in their networks.

Once a provider completes the process, automatic reminders are sent each quarter to prompt a review and update of the information. Updates can be entered at any time; providers can even use the database to communicate changes in addresses, phone numbers and any other practice related information.

Humana network providers and ChoiceCare Network providers who have not already received a registration kit with their CAQH identification number from other participating plans in their service area will soon receive this information along with detailed instructions on how to access and use the database.

Alternatively, applications can be requested by mail through the CAQH
Help Desk at (888) 599-1771. Once complete, applications can be submitted
by fax to the following toll-free number: (866) 293-0414. The Help Desk can also provide technical support from 8 a.m. to 8 p.m. EST weekdays for use of the CAQH Web site: https://caqh.geoaccess.com.

Humana believes the relationship with CAQH will help simplify the credentialing process for participating providers. If you have any questions about this change,
contact the Humana Credentialing Department in your area.

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