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Compliance
Utilizing Council for Affordable Quality Healthcare (CAQH) data in your credentialing process is a huge advantage because it is the largest, most trusted source of healthcare provider information. But it doesn’t mean you are immune to common CAQH credentialing errors, which can cause delays and workflow disruptions.
CAQH itself doesn’t manage the healthcare credentialing process: it simply houses the data. It’s up to each provider and organization to monitor, maintain, and act on that data in a timely and accurate way. A simple data mismatch can create risk for credentialing teams who depend on accurate data and a reliable information management system to succeed.
The good news? With advancements like automation, reminders, increased visibility, and data integration, robust healthcare credentialing software gives your credentialing team the tools to manage CAQH data proactively, reducing delays, boosting accuracy, and ensuring nothing falls through the cracks.
In this blog, we’ll break down five of the most common CAQH credentialing errors, as well as how technology and CAQH data integration can help you prevent them before they disrupt your operations.
5 Most Common CAQH Credentialing Errors
1. Provider Attestation Expiration
The first common CAQH credentialing error is dependent on individual healthcare providers who must attest their CAQH profile every 120 days. If the attestation expires, their profile becomes inactive, which can impact recredentialing and even payer enrollments. With all the work that keeps providers busy, remembering an attestation date can easily become a needle in a haystack.
Using healthcare credentialing software that sends automated reminders of upcoming attestation dates can help prevent lapses, keeping provider profiles active and your operations moving forward.
2. Inaccurate Or Incomplete Profiles
Often, CAQH provider profiles are not at the top of the list to update when there’s a life event like a marriage or move, and this results in missing or outdated information. It becomes an issue when a payer notices the discrepancy and denies claims. Or when incorrect information is published in insurance directories, making it hard for patients to find the provider. Remembering to re-attest a profile puts an unnecessary burden on busy practicing healthcare providers.
This can be solved by setting up credentialing tracking and reporting with all CAQH re-attestation dates and scheduling it to be sent monthly. In addition to catching the providers at risk of expiration, it will also jog the credentialing team’s memory of marriages or practice changes that should be updated proactively.
3. Changing Requirements
CAQH requirements change over time, making compliance an ever-evolving task that’s challenging to keep up with. You need a system that adapts as fast as the rules do. All-in-one platforms help you stay ahead of changes by building flexible, customizable workflows that can evolve as requirements shift, without disrupting your entire process.
When a platform pulls provider data directly from CAQH and centralizes it in real time, credentialing teams always have the most current profile information at their fingertips. That means fewer manual updates, fewer missed requirements, and a lot more confidence heading into enrollment or audit season.
CAQH University offers helpful trainings for credentialing staff, making it easier to adjust to common CAQH credentialing errors and regulatory changes.
Increase Credentialing Speed and Accuracy With Next-Gen Technology
4. Lack of Visibility
Without visibility into a provider’s CAQH profile, credentialing professionals can’t know if the information is accurate and the attestation is complete. This can make it harder to credential new providers and maintain the enrollment of existing providers, leading to lost time and revenue.
This can be solved by using software with a direct CAQH integration that imports data on demand. That way, credentialers have access to the provider’s most recent information. It’s a second set of eyes to ensure CAQH data is accurate and ready for recredentialing.
5. Fragmented Systems
Oftentimes, credentialing teams try to patch together manual workarounds to prevent common CAQH credentialing errors. However, in many cases, using different technologies and software results in a disjointed system that likely fails to truly solve the original issue, and could even present new problems itself.
Rather than trying to pull together many software solutions, choose one that offers the functionality your organization needs. If provider data accuracy is one of your organization’s biggest issues, then find a vendor with a direct CAQH integration, rather than vendors who “scrape” data from CAQH or other less reliable methods.
Solve Common CAQH Credentialing Errors With MedTrainer
Leveraging technology to help your organization upgrade its credentialing strategy can make these common CAQH credentialing errors a problem of the past. Healthcare credentialing software that takes the guesswork out of CAQH credentialing will streamline your process, avoid common errors, and help your credentialing team onboard providers more efficiently to begin generating revenue quicker.
MedTrainer credentialing software works with CAQH through an official, permission-based API to pull provider data directly from the database. From there, you can be confident in the accuracy of your provider data and leverage powerful automations, such as auto-filling credentialing forms, using MedTrainer’s provider profile. MedTrainer gives you unmatched visibility into the credentialing process, while also lessening the administrative burden of tackling dozens of highly-specialized form types and manually monitoring changing requirements and expiration dates.
With MedTrainer, you get an all-in-one credentialing system that works together with CAQH to provide an easy-to-use solution, helping healthcare professionals work smarter, not harder.
Ready to see how MedTrainer can help your organization upgrade its credentialing strategy? Schedule a demo today.