Credentialing and CAQH

Credentialing of health care professionals and facilities

Credentialing is the process of obtaining and reviewing documentation to determine participation status in a health plan. The documentation may include, but not be limited to, the applicant's education, training, clinical privileges, experience, licensure, accreditation, certifications, professional liability insurance, malpractice history and professional competence. Generally, the terms credentialing and recredentialing include the review of the information and documentation collected, as well as verification that the information is accurate and complete.

Please note:

Credentialing process

Humana requires the use of CAQH ProViewTM, a service that provides a fast and easy way to securely submit credentialing information to multiple plans and networks by entering information just once. Application data can be submitted online at any time. This simplified credentialing process reduces paperwork and saves time. It is provided at no cost.

Arkansas health care professionals are not required to use CAQH ProView and should contact their state medical board to determine its required credentialing procedures.

To become credentialed for the first time, you will need a current and complete CAQH ProView application, which includes:

  • All requested information (If the information requested is not applicable, please mark it as “not applicable.”)
  • All questions answered, including any necessary explanation
  • Attestation, signature and date
  • Copy of curriculum vitae, including work history in a month/year format
  • Copy of Drug Enforcement Agency and/or Controlled Dangerous Substances (CDS) certificate
  • Copy of malpractice insurance face sheet
  • Summary of pending or settled malpractice cases

Please be sure to grant Humana access to the CAQH ProView application.

Getting started

Physicians and other health care professionals obtain their CAQH Provider ID directly from CAQH by going to https://proview.caqh.org/pr (link opens in new window) and completing a registration form. Once the form is submitted, the applicant will receive an email from CAQH with a CAQH Provider ID. Then, he/she will be able to log into CAQH ProView and create a user name and password, which are used to complete the online application.

The process incorporates the Standard Application Data Set and, where appropriate, accounts for additional credentialing information required by states with specific application mandates. Before the completed application is available to a participating organization or health plan, the applicant must authorize release of the data. Each organization that has included the applicant on its roster will appear on the authorization screen for the health care professional to review and authorize.

The applications are stored in an online database and are always available to the applicant to review or print.

Once a physician or other health care professional completes the process, automatic reminders are sent each quarter to prompt a review and update of the information.

After you receive your CAQH ID, visit our contracting web page (link opens in new window) to begin a contract application.

For more information about CAQH, please visit CAQH's website and select “CAQH ProViewTM."

If you cannot participate with CAQH ProView, please contact your local market representative.