CAQH software assists the efforts of payer credentialing

A national healthcare agency is releasing CAQH software to automate and streamline the method by which providers submit data to health insurers to become a credentialed provider.

The application was established by CAQH, a healthcare stakeholder organization that works with providers and payers to make better the business processes.

The new product of CAQH software, termed as VeriFide, will automate almost all of the provider information-checking process for insurers—although, a few data elements are’t yet available for automation, CAQH notes.

Generally, insurers are needed to re-credential providers every 3 years. CAQH already has another product, termed as CAQH ProView that providers use to enter the professional information important for re-credentialing with insurers. CAQH software assisted the efforts of payer credentialing.

Insurers have had to verify the fourteen types of provider-submitted information themselves or through a contractor, a laborious and costly endeavor. This involves information on medical school graduated from, hospital where trained and license number, among other data.

VeriFide presently integrates with most state licensing boards, the National Technical Information Service for Drug Enforcement Agency verification, most state agencies managing controlled dangerous substance permits, the National Practitioner Data Bank, American Board of Medical Specialties, the Office of Inspector General Exclusions Database, American Board of Medical Specialties, the System for Award Management exclusion records and CAHQ ProView, with more sources expected in coming months.

VeriFide was established to help payers and providers, claims Robin Thomashauer, executive director.

Right now, providers have different dates for submitting credentialing data to insurers, and each insurer they deal with has a different date, which is a burden to providers.

Over time, VeriFide will align re-credentialing dates so each provider has merely one date for all of its payers, in accordance to Thomashauer.

The effort will take numerous years, but the concept is to decrease the reporting burdens and confusion for providers by having them contacted just once every 3 years by CAQH to have their credentialing data verified.