Credentialing and CAQH

Credentialing of physicians and other health care providers

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.

To begin this process, 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, the applicant 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 for individual providers 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 for health care providers and their staff members. Best of all, this service is provided at no cost to participating health care providers.

  • Individual health care providers wishing to join the 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.
  • Health care providers need to grant Humana access to their applications on CAQH ProView in order for Humana to utilize them.
  • The application on CAQH also must be current and have all of its sections filled out completely as specified within the application.
  • Current documentation (e.g., licensure and certifications) also must be attached as directed.

Health care providers who also may be eligible to use CAQH ProView through Humana include those listed in the chart below.

Potentially eligible health care providers
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

Health care providers 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 health care provider 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 health care provider must authorize release of the data. Each organization that has included the health care provider 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 health care provider to update, review or print.

Once a health care provider 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."