A lot of ABA therapists and solo practitioners feel like they spend an uncomfortable amount of time working on paperwork and documentation when they would rather be focusing on their patients. The tedious nature of things like coding and medical billing documentation can rob small practices and solo ABA practitioners of too much precious time.
In recent years CAQH has stepped up to help streamline these processes. Though how it works and how to become credentialed in their database requires a little up-front attention to detail.
What Is CAQH?
The Council for Affordable Quality Healthcare or CAQH was originally founded in 1998 as part of the Coalition for Affordable, Quality Healthcare. It is a non-profit business designed to help streamline a lot of the time-consuming processes that take precious time away from medical and psychological service providers.
CAQH has a rapidly increasing membership that includes insurance providers like Aetna, Blue Cross Blue Shield, Anthem, Priority Health, Cigna, and UnitedHealth. Just to name a few.
What Does CAQH Do?
CAQH helps streamline a lot of the clerical work and administrative tasks posed by small practices and solo practitioners throughout the healthcare industry. This helps make it easier for insurance companies and practitioners to stay on the same page when it comes to patient treatment, coding, and medical billing.
CAQH & CORE
Within CAQH there is the Committee on Operating Rules for Information Exchange (CORE). It was added to the counsel in 2005 to develop and facilitate universal operating rules within the healthcare industry. Today it’s estimated that more than 75% of the healthcare organizations operating in the United States are CORE-certified healthcare organizations. This includes a lot of Medicare and Medicaid beneficiaries.
To this point, CORE is recognized by the Department of Health and Human Services (HHS) as an author of ACA operating rules.
Over the years CORE has helped develop standards to facilitate healthcare providers and practitioners in a wide range of coding and medical billing practices. They have helped standardize information that is made available to all parties involved in a medical transaction.
What Is CAQH ProView?
ProView is an initiative within CAQH that provides professionals with key demographic information that can be used by health plans, hospitals, and providers for their network directories, credentialing, and claim payment needs. In this way, ProView further helps streamline these processes and also helps reduce problems with duplicate paperwork.
A lot of ProView, practitioners also use a program known as DirectAssure to self-report and certify key information about their practice. DirectAssure is also integrated VeriFide to further standardize the credentialing process used by health plans to verify a practice’s information.
What Is COBSmart?
COBSmart is another initiative that’s designed to help identify patients with overlapping health coverages and coordinating coverages. This helps determine who is considered to be the primary and secondary insurance plan. This goes a long way toward ensuring that health services are correctly billed the first time. It then reduces the risk of claim denials, rejections, and delays for the provider. By coordinating coverage for ABA services, it can also reduce the out-of-pocket costs paid by families.
What Is CAQH Explorations?
CAQH’s continued evolution to better serve the medical industry includes its research arm, known as CAQH Explorations, which includes the CAQH Index. This Index archives information about progress in a variety of trends throughout the healthcare industry including the increasing use of electronic transactions.
How Important Is Credentialing?
Accurate credentialing is a core feature of CQH. The earlier a solo ABA practitioner or small practice becomes credentialed with CAQH, the more likely providers are to streamline their reimbursement rates. This leads to a more consistent revenue stream.
A lot of insured patients struggle to find just the right ABA practitioner in their network. Especially since most of the time going out of network providers sticks them with higher out-of-pocket costs. This means that most patients try to find in-network care whenever it’s possible.
By credentialing with different insurance companies through CAQH your practice will also increase your potential patient pools. At the same time, a lot of insurance patients will be much more likely to see you if you’re a participating provider within their insurance network.
The CAQH Application Process
The CAQH application process is a little more involved than some other credentialing processes, but it also offers a broader scope of payer institutions. Once your ABA therapy practice is credentialed through CAQH it will also streamline your coding and medical billing practices.
Getting your information together before starting the application process is very helpful. A lot of the information required in the CAQH application will be second nature to you. Though some things like insurance certificates, ID numbers, and hospital affiliation data might need to be collected and written down in advance to ensure that you aren’t left scrambling while filling out the application.
Before starting the CAQH application process, you should gather the following data:
- Basic Personal Information
- Education and Training
- Where you attend medical
- Where you attended graduate school
- Internships and residencies performed
- Fellowships and preceptorships granted
- Teaching appointments served
- Specialties and Board Certification
- Practice Information
- Practice name and type
- Up-to-date address and contact information
- Billing information
- Your office manager’s information and their credentialing information
- Services, certifications
- Note any limits on your hours of operation
- Partners and colleagues in your practice
- Hospital Affiliation Information
- Your malpractice insurance information
- Work History and References
- Disclosure documents relating to your past malpractice history
How To Fill Out The CAQH Application
There are six basic steps in the CAQH application process. Following each of them in order ensure that you won’t have to go back later.
- Step One: Register with CAQH
- Step Two: Answer all application questions
- Step Three: Audit your application to double-check accuracy and make sure all necessary fields are filled out.
- Step Four: Authorize organizations that participate with the CAQH to access your data
- Step Five: Attest to the data in your application
- Step Six: Submit all documentation, including insurance certificates, and BCBA certificates
CAQH Tips & FAQ
The following tips can help streamline the CAQH application process for ABA practitioners and small practices throughout the healthcare industry.
Don’t Delay
CAQH no longer requires an invitation to be sent out to you. You can apply yourself. Though if you’ve applied in the past, you will likely need to fill out a new application.
Set Aside At Least 2 Hours
It generally takes around two full hours to complete a CAQH application. You might be able to shave this time down by making sure to have the following information readily at hand.
- Your CV or Resume
- Explanation of any gaps in employment
- Your BCBA Certificate
- Additional Licensed Provider Certificates
- Practice Information
- The W9 for your practice
- Liability insurance for individual or practice
- References
Audit Your Information
The Audit review in the CAQH application will note areas where information needs to be added or corrected. This includes noting any required fields that might be empty. Make sure to click on the hyperlinks and correct each item and run the review again. When you are done, attest once all audit/review checks have passed without error.
