How much does medical billing cost?

Medical billing pricing varies by practice size. Our plans range from $300/month flat rate for practices under $10K monthly collections to 2.99% for practices over $40K/month. We offer percentage-based and flat-rate options.

How long does provider credentialing take?

Provider credentialing typically takes 45-90 days on average. Medicare credentialing takes 60-90 days, Medicaid 30-60 days, and commercial payers 60-120 days depending on the network.

What is a virtual assistant in healthcare?

Healthcare virtual assistants handle administrative tasks like appointment scheduling, insurance verification, prior authorizations, patient follow-up, and medical records coordination. They reduce no-shows by 40% and free staff to focus on patient care.

What is CAQH and why do I need it?

CAQH (Council for Affordable Quality Healthcare) is a universal provider database used by most commercial insurance companies for credentialing. You need a complete CAQH profile to get enrolled with most payer networks.

How can I reduce medical claim denials?

To reduce claim denials: verify insurance eligibility before visits, ensure accurate medical coding, submit complete documentation, file claims within timely filing limits, use claims scrubbing software, and appeal denials within 48 hours.

CAQH Profile Setup: Complete Step-by-Step Guide

What Is CAQH ProView?

CAQH ProView (Council for Affordable Quality Healthcare) is a free, centralized database where healthcare providers store their credentialing information. Over 1,000 health plans and healthcare organizations pull provider data from CAQH instead of requiring separate applications.

Why CAQH matters:

Required by most commercial insurance payers for credentialing
Speeds up enrollment by eliminating redundant applications
Standardizes provider information across all payers
Free for healthcare providers (funded by participating organizations)
Accessible 24/7 for updates and maintenance

Key Fact:

An incomplete or unattested CAQH profile will halt ALL credentialing applications until corrected. Keeping it current is non-negotiable for practicing providers.

Setting up CAQH correctly is crucial—but it's also time-consuming. Medfolio handles complete CAQH profile setup for just $75, ensuring accuracy, compliance, and faster credentialing. Learn more about our credentialing services.

Who Needs a CAQH Profile?

The following healthcare professionals must maintain CAQH profiles:

Physicians (MD, DO)
Nurse Practitioners (NP)
Physician Assistants (PA)
Clinical Psychologists
Licensed Clinical Social Workers (LCSW)
Physical Therapists, Occupational Therapists
Chiropractors
Dentists (DDS, DMD)
Podiatrists (DPM)
Optometrists (OD)

If you're a solo practitioner or part of a group practice seeking insurance panel participation, you need a CAQH profile.

Step 1: Register for CAQH ProView

Initial Registration Process

1. Visit the CAQH ProView website: Go to proview.caqh.org

2. Click "Register" and select your provider type

3. Enter your NPI (National Provider Identifier)
Don't have an NPI? Apply at nppes.cms.hhs.gov first. NPI applications take 1-2 weeks to process.

4. Provide contact information:

Legal name (must match medical license exactly)
Date of birth
Social Security Number
Email address (you'll use this to log in)
Phone number

5. Create a password and security questions

Pro Tip:

Use a professional email address you'll have long-term. Avoid practice emails if you might change employers—CAQH profiles follow the provider, not the practice.

Step 2: Complete Personal Information Section

Once registered, complete all sections of your profile. This typically takes 2-4 hours if you have all documents ready.

Personal Information

Full legal name (including any suffixes like Jr., Sr., III)
Previous names (maiden names, name changes)
Home address (not required by all payers)
Primary practice address
Additional practice locations
Billing address (if different)
Contact phone and fax numbers
Email addresses

Professional IDs

NPI (Individual Type 1 NPI)
State medical license number(s) for all states
DEA number (if prescribing controlled substances)
Medicaid ID numbers (all states where enrolled)
Medicare PTAN (if Medicare enrolled)
State-specific provider IDs

Specialty & Taxonomy Codes

Select your primary and secondary specialties. Use standard taxonomy codes (e.g., 207R00000X for Internal Medicine).

Step 3: Upload Required Documents

This is the most time-consuming part. Gather these documents before starting:

Required Documents Checklist

1. Medical Licenses (All States)

Current license for each state where you practice
Upload front and back of license
Must be unexpired (upload renewals immediately)

2. DEA Certificate

Required if you prescribe controlled substances
Upload current DEA certificate
DEA renewals happen every 3 years

3. Board Certifications

ABMS or AOA board certification certificates
Include primary and any subspecialty certifications
Note expiration dates (most are time-limited)

4. Professional Liability Insurance (Malpractice)

Current declarations page or certificate of insurance
Must show coverage amounts (typically $1M/$3M minimum)
Must list you by name (not just the practice)
Update annually when policy renews

5. CV (Curriculum Vitae)

Professional format with complete work history
No gaps in employment (account for all time since medical school)
Include dates for all positions (month/year)
List publications, presentations, and honors

6. Education & Training Certificates

Medical school diploma
Internship completion certificate
Residency completion certificate
Fellowship completion certificate (if applicable)

7. Hospital Affiliations & Privileges

List all current hospital privileges
Upload privilege letters or credentialing letters
Include privilege type (active, courtesy, admitting)

Important:

All documents must be clear, legible, and in PDF format. Blurry photos or incomplete documents will delay credentialing. Scan at 300 DPI minimum.

Step 4: Complete Work History

List your complete work history from medical school graduation to present. Payers are looking for gaps or unexplained periods.

For each position, include:

Employer name and address
Position/title
Start and end dates (month/year)
Reason for leaving
Supervisor name and contact info

Accounting for gaps: If you have any employment gaps (maternity leave, sabbatical, illness, research, travel), document them with explanations. Gaps over 30 days trigger questions from payers.

Step 5: Disclosure Questions

CAQH includes mandatory disclosure questions. Answer honestly—all information is verified through primary sources like the National Practitioner Data Bank.

Typical disclosure questions:

Malpractice claims or settlements
License suspensions, restrictions, or disciplinary actions
DEA restrictions or sanctions
Medicare/Medicaid sanctions or exclusions
Hospital privilege restrictions or loss
Felony or misdemeanor convictions
Drug or alcohol treatment

If you answer "yes" to any question, you'll need to provide detailed explanations and supporting documentation. "Yes" answers don't automatically disqualify you, but omitting information does.

Step 6: Review and Attest

Once all sections are complete, carefully review every field. Errors discovered later require corrections and re-attestation.

Attestation process:

Review the attestation statement
Check the box certifying accuracy
Electronically sign and date
Your profile status changes from "Incomplete" to "Active"

Critical Requirement:

You must re-attest your CAQH profile every 120 days (4 months). Set a recurring calendar reminder. If your profile becomes "unattested," all credentialing applications halt immediately.

Ongoing Maintenance

Re-Attestation (Every 120 Days)

CAQH sends email reminders 30, 14, and 7 days before your attestation expires. Don't ignore these emails—an expired profile stops all credentialing.

Don't want to worry about re-attestation deadlines? Medfolio's credentialing team monitors your CAQH profile and handles all 120-day re-attestations as part of our ongoing credentialing support. We ensure your profile never expires.

Re-attestation takes 5-10 minutes:

Log into CAQH ProView
Review your profile for any changes
Update any outdated information
Click "Attest" and sign electronically

When to Update Your Profile

Update your CAQH profile immediately when:

You renew your medical license or DEA
Your malpractice insurance renews
You change practice locations or phone numbers
You obtain new board certifications
You gain or lose hospital privileges
You change your name
You add a new state license

After making updates, you must re-attest for changes to take effect.

Common CAQH Mistakes to Avoid

1. Name Mismatches

Your name in CAQH must match your medical license exactly, including suffixes, middle names, and punctuation.

2. Expired Documents

Uploading expired licenses, DEA, or malpractice insurance causes rejections. Check expiration dates before uploading.

3. Employment Gaps

Unexplained gaps in work history trigger delays. Account for ALL time since medical school, including sabbaticals and leaves.

4. Missing Attestation

Completing your profile isn't enough—you must click "Attest" for it to become active.

5. Ignoring Re-Attestation Reminders

Missing the 120-day re-attestation deadline stops all credentialing immediately.

How Payers Use Your CAQH Profile

Once your CAQH profile is active, insurance payers can access it through their CAQH account. They use your information to:

Pre-fill credentialing applications
Verify professional qualifications
Check license and certification status
Conduct background checks
Update their provider directories

You can track which organizations have viewed your profile in the "Profile Activity" section.

CAQH vs. Individual Payer Applications

While CAQH streamlines credentialing, most payers still require supplemental applications for:

Practice-specific information (TIN, group NPI)
Service location details
Contracted reimbursement rates
W-9 forms and banking information
Payer-specific attestations

Think of CAQH as the foundation—it provides 80% of the information payers need, but you'll still complete payer-specific forms for the remaining 20%.

Let Medfolio Handle Your CAQH Profile

Our CPCS-certified credentialing specialists set up and maintain CAQH profiles as part of our comprehensive provider credentialing service. We handle document gathering, profile completion, and 120-day re-attestations.

Service includes: Initial CAQH setup, document preparation, profile monitoring, re-attestation reminders, and updates as needed. See our transparent pricing for credentialing services starting at $150.

Get Help with CAQH Setup

Conclusion

Setting up your CAQH ProView profile is a one-time investment of 2-4 hours that pays dividends throughout your career. A complete, accurate profile speeds up credentialing with every payer and reduces application rejections.

The key to success: gather all documents before starting, enter information carefully, and set recurring reminders for 120-day re-attestation. An active, current CAQH profile is essential for maintaining your practice's revenue flow.