Credentialing and CAQH

Credentialing of physicians, clinicians and facilities

Credentialing is the process of obtaining and reviewing documentation for the purpose of determining participation privilege status in the health plan. Such documentation may be provided by the applicant and/or obtained during the process. 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.

The contents of this web page do not apply to Puerto Rico. For information on Puerto Rico credentialing, please send an email to PRCredentials@humana.com or call 1-877-384-5037.

If you are currently credentialed and interested in recredentialing, please visit this web page.

To become credentialed for the first time, you will need:

  • Current and completed CAQH ProViewTM application*, Humana credentialing application or state-mandated credentialing application, which includes:
  • - All requested information (If the information requested is not applicable, you will need to 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 DEA and/or CDS Certificate
  • - Copy of malpractice insurance face sheet
  • - Summary of pending or settled malpractice cases

*Access to the CAQH ProView application must be granted to Humana

CAQH ProView

Humana participates with CAQH ProView, 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.

  • Individuals wishing to join the Humana network may use CAQH ProView for the initial credentialing process.
  • A CAQH ProView application can be used in lieu of completing a Humana application during the recredentialing process. See our recredentialing page for details.
  • Applicants need to grant Humana access to their applications on CAQH ProView in order for Humana to utilize them.
  • The application on CAQH must be current and have all of its sections filled out completely as specified within the application.
  • Current documentation (e.g., licensure and certifications) must be attached as directed.

Those who may be eligible to use CAQH ProView through Humana include those listed in the chart below.

Potentially eligible physicians and clinicians
Audiologist Certified registered nurse Certified registered nurse anesthetist Clinical nurse specialist
Clinical psychologist Clinical social worker Doctor of chiropractic Doctor of dental medicine
Doctor of dental surgery Doctor of osteopathy Doctor of podiatric medicine Licensed practical nurse
Marriage/family therapist Medical doctor Midwife Neuropsychologist
Nurse midwife Nurse practitioner Occupational therapist Optometrist
Physician assistant Physical therapist Professional counselor Registered nurse
Registered nurse first assistant Speech pathologist    

How it works

Physicians, clinicians and facilities 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 also, 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 provider to review and authorize.

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

Once a physician, clinician or facility 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 to begin a contract application.

For more information about CAQH, please visit CAQH's website (link opens in new window)  and select “CAQH ProView."