The Complete CAQH Credentialing Checklist

Now that we’ve covered the basics of the Council for Affordable Quality Healthcare (CAQH), a thorough CAQH credentialing checklist helps providers gather all necessary information and documents before starting their Council for Affordable Quality Healthcare (CAQH) ProView profile. Ensuring you have every required detail on hand will make the CAQH process much smoother. Use the following CAQH credentialing checklist to prepare all the key data and documentation you’ll need for your profile. 

Posts in this series

• What CAQH Is: Basics and Credentialing
• The Complete CAQH Credentialing Checklist
• CAQH Credentialing Timeline and Benchmarks
• 7 Common CAQH Credential Mistakes and How to Avoid Them
• CAQH Alternatives: ProView, PECOS, Medicaid, and Direct Payers
• Continuous Primary Source Verification (and Other Advanced CAQH Topics)
• Credentialing Management Software, Tools and Automation
• CAQH Credentialing FAQs and Case Studies

Information needed for CAQH credentialing 

• Personal and demographic information:  

• • Full legal name (and any aliases or maiden names) 

• • Date of birth 

• • Social Security number (if required by a payer) 

• • Gender 

• • Citizenship 

• • Languages spoken 

• • Home contact information 

• • Professional headshot photo (some plans request a photo for directories) 

• Professional identifiers:  

• • National Provider Identifier (NPI) number (type I individual NPI) 

• • Medicaid ID (if applicable) and Medicare PTAN if linking to a group (for group practices) 

• • Tax Identification Number (TIN/EIN) and business name as on your W-9, since you’ll upload a W-9 form. 

• Education and training: 

• • Medical/professional school details (name, degree, graduation date) 

• • Internship, residency, fellowship training programs (with start/end dates and specialty) 

• • Any other graduate degrees or professional training. International graduates should have Educational Commission for Foreign Medical Graduates (ECFMG) certificate information. 

• Licenses and certifications: 

• • All active state professional licenses (state, license number, issue and expiration dates) 

• • DEA registration number and expiration (if you prescribe controlled substances) 

• • State-specific controlled substance permits for states that require them 

• • Board certification status for each specialty (board name, certification year, expiration if any), or if not board certified, note board eligibility or other qualifications 

• • Any additional certifications 

• Work history:  

• • Here, put in a detailed chronological work history for the past five years, with no gaps over 90 days.  

• • Start and end dates (month/year) for each position 

• • Professional references or contacts for your work history  

• • Typically, CAQH asks for the name, title, phone/email of a direct supervisor or peer for your current practice and perhaps past jobs (some plans require up to three references). Gather reference contact info in advance by reaching out to former supervisors or colleagues. 

• • Include all clinical employment, self-employment, moonlighting, military service, and significant volunteer positions. 

• • For any unemployment or extended time off of more than three months, you’ll need to provide a brief explanation (e.g., “Maternity leave from June-Dec 2023” or “Studying for boards”).  

• Practice details:  

• • Information for each practice location where you see patients, including: 

• • Clinic or hospital name  

• • Street address 

• • Phone and fax numbers 

• • Your start date at that location 

• • The office manager or credentialing contact 

• • Whether you are accepting new patients at that site (for directory purposes) 

• • (If you are part of a group practice): the group name and tax ID. Ensure the addresses match exactly with what’s on file in other systems to avoid mismatches (even a missing suite number can cause issues). 

• Hospital privileges:  

• • Include any hospitals or surgical centers where you currently have admitting or treatment privileges, along with status (active, courtesy, etc.) 

• • If you do not have hospital privileges (e.g., outpatient-only provider), you may need to note your plan for admissions, such as an admitting arrangement with a hospitalist or a transfer agreement) Some insurers require hospital privilege info or an admitting plan for certain specialties. 

• Malpractice insurance:  

• • Your current professional liability insurance details:  

• • Carrier name 

• • Policy number 

• • Coverage limits 

• • Expiration date. 

• • A copy of the malpractice insurance certificate (face sheet) showing your name as insured 

• • Ensure your coverage meets any minimum requirements the payers or hospitals have (many require $1M/$3M coverage, for example).  

• • Malpractice claim history: CAQH will ask if you’ve had any malpractice suits or settlements and may require details for any in the past five to 10 years (sometimes a separate form or narrative for each case). 

• Background disclosure:  

• • When completing your disclosure, you will answer “Yes” or “No” to questions about the following topics: 

• • Malpractice claim details (incident date, what happened, settlement amount) 

• • Any license disciplinary actions or board citations 

• • Any criminal convictions 

• • Medicare/Medicaid sanctions 

• • Oher credentialing denials.  

• • Prepare explanations for any “Yes” answers to disclosure questions. Having a written narrative and documentation for these events will be important to upload or send to payers if requested.  

• • If you have no such history, you’ll simply attest “No” to all. 

• • Attestation and consent: At the end of the profile, you’ll confirm that everything is accurate to the best of your knowledge. This is a legal confirmation — be prepared to stand by the information you provided. (If you are using a credentialing service to fill out your information on your behalf, you will still personally need to attest to its accuracy; do not skip reviewing what they entered.) Additionally, you’ll authorize use of your info as needed for credentialing and directory purposes. 

Documents required for credentialing 

In addition to filling in the data previously mentioned, make sure you have digital copies (PDF or image) of the following documents ready to upload into CAQH: 

• State license for each state of practice (current certificate) 

• DEA certificate (if you have one) and any state Controlled Dangerous Substance certificate, if applicable 

• Board certification certificate(s) or proof of board eligibility 

• Malpractice insurance face sheet (current policy showing your name, dates, and coverage) 

• Curriculum vitae (CV)/resume updated with your complete work and education history 

• W-9 form, signed and dated, for your practice’s tax ID 

• ECFMG certificate if you are a foreign medical graduate 

• Training certificates sometimes requested (diplomas for medical/graduate school, and certificates for completion of residency/fellowship) 

• Hospital privilege letter or admitting arrangement letter if required (some plans ask for a letter proving how you cover hospital care if you have no privileges) 

• Photo ID is rarely needed by CAQH itself, but some organizations might ask for a copy of a driver’s license or passport for verification 

• Passport-size photo (professional headshot), which some payers use for directories. Having a professional photo ready to upload is a good idea 

By using this checklist, you can assemble everything you need before logging into CAQH. Being prepared will prevent the profile from sitting incomplete while you hunt down documents. As one clinician noted. Once your CAQH application is fully filled out, double-checked, and all items above are uploaded and attested, you’ll be ready to share it with health plans for credentialing. 

Now that you have an understanding of CAQH credentialing and this helpful checklist, the next post in this series will cover common mistakes clinicians make and how to avoid them.