CAQH ProView: keeping your 120-day attestation current

Why CAQH matters

CAQH ProView is the shared provider data system that a large majority of commercial health plans, and many Medicaid managed care plans, use during enrollment and re-credentialing. Instead of filling out a separate credentialing application for every payer, a provider maintains one profile and authorizes plans to view it.

That convenience comes with a catch. Plans treat the profile as the provider's official record. If it is incomplete, out of date or unattested, payers cannot proceed, and they often do not tell you right away. A file can sit in a plan's queue for weeks while staff wait for a profile that was never going to update itself.

ProView is free for providers. Plans pay to participate, which is why the provider's job is simply to keep the profile complete, current and attested.

What lives in a ProView profile

A complete profile covers essentially everything a credentialing committee needs to evaluate a clinician. Expect to provide, and keep current, the following information.

• Personal details, including legal name, other names used, date of birth and Social Security number.
• Individual NPI, and group NPI and tax ID for each practice the provider works with.
• State licenses, DEA registrations and controlled substance certificates for each state.
• Education, residency, fellowship and board certification history.
• Practice locations, office hours, phone numbers and accessibility details.
• Hospital affiliations and admitting arrangements, or the covering provider if none.
• Malpractice insurance carrier, policy number, limits and current certificate.
• Five or more years of work history, with written explanations for gaps.
• Disclosure questions covering licensure actions, malpractice claims and health status.
• Uploaded supporting documents such as the license, DEA, certificate of insurance and CV.

The 120-day rule

Providers must re-attest that their ProView information is complete and accurate every 120 days. Attestation is a formal statement, signed electronically, that the provider has reviewed the profile and that it is true. When attestation lapses, the profile is generally no longer available to participating plans until it is re-attested.

A lapsed attestation does not only affect new applications. Plans re-credential providers on a cycle, commonly every three years, and pull the CAQH profile to do it. A profile that is expired at the moment a plan reaches for it can trigger reminder letters, delays and in some cases termination from the network if the provider does not respond in time.

The system sends reminder emails as the deadline approaches, but those emails often go to an address nobody monitors, such as a former office manager or a personal inbox. Relying on them alone is one of the most common reasons attestations slip.

Authorizing plans to view the profile

Completing a profile is not enough on its own. Each plan must be authorized to view it. Providers can authorize all participating plans at once or choose specific plans. If a plan is not authorized, it cannot see the profile even if every field is perfect.

When a payer says it cannot find your CAQH information, check authorization first. It is a quick fix that is surprisingly often missed, especially after a provider joins a new group or a plan is added to the practice's payer mix.

Common profile problems that stall payers

Most CAQH issues are small and fixable, but each one can stop a review.

• Expired documents: a malpractice certificate or license that renewed but was never uploaded.
• Mismatched addresses: a suite number or ZIP code that differs from NPPES or the application.
• Missing locations: a new office that was added to the practice but not to the profile.
• Unexplained work history gaps: plans usually ask about any gap longer than six months.
• Incomplete hospital affiliation: no admitting privileges and no covering arrangement listed.
• Wrong group linkage: the provider is tied to a previous employer's tax ID.
• Outdated disclosure answers: an answer that changed but was not updated before attesting.

Who should own the profile

Providers own their profiles and are responsible for attesting, but in most practices a credentialing coordinator or enrollment partner does the day-to-day maintenance with the provider's permission. That works well when responsibilities are clear and poorly when everyone assumes someone else is watching.

Decide in writing who updates documents, who monitors attestation dates and who has login access. When a provider leaves the practice, update practice affiliations promptly so plans are not reading stale information, and make sure the departing provider's profile is no longer tied to the group's locations.

A simple maintenance routine

Treat CAQH as a living record, not a one-time setup. A light, regular routine prevents almost every problem described above.

• Track each provider's attestation date and set reminders at 90 and 105 days.
• Re-attest early rather than on the last day; attesting resets the 120-day clock.
• Upload renewed licenses, DEA and malpractice certificates as soon as they are issued.
• Keep practice locations and addresses identical to NPPES and payer applications.
• Review disclosure answers before every attestation, not just the first time.
• Confirm each payer you work with is authorized to view the profile.
• Update the profile within days of any change in practice, location or group.
• Keep a copy of every document uploaded, with its expiry date, in your own records.

Setting up a new provider's profile

For a new hire without a profile, registration typically starts with the provider's NPI. Once the profile is created, collect every document in one pass before entering data, because partially completed profiles are easy to forget and cannot be attested.

Work through the profile in order, upload documents in clear, legible formats, explain any gaps in plain language, authorize plans and attest. Then, before submitting any commercial application, check that what the application says matches the profile exactly. Plans compare the two, and differences create questions.

How CAQH fits into the wider enrollment picture

CAQH is central for commercial plans, but it is only one record among several. Medicare uses PECOS, state Medicaid programs use their own portals, and every payer compares what it sees against licensure records and NPPES. Keeping CAQH current is necessary, but it works best as part of a process that keeps every record consistent.

Practices that combine a current CAQH profile with clean, matching data everywhere else see fewer requests for information, faster approvals and smoother re-credentialing cycles.