CAQH ProView

CAQH ProView is a provider data management solution offered by CAQH (Council for Affordable Quality Healthcare). According to the vendor, the product aims to streamline the credentialing process, improve directory data and management, and enhance data quality for healthcare organizations. It is designed for healthcare organizations of all sizes, including large health systems, hospitals, medical groups, and individual practitioners. The solution caters to various professions and industries, such as physicians, dentists, healthcare facilities, health plans, insurance companies, and medical practices.

Key Features

Streamline Credentialing: According to the vendor, CAQH ProView provides a centralized portal for entering, verifying, and updating professional information, aiming to simplify the credentialing process for healthcare organizations. The product automates credentialing processes, potentially reducing administrative burden and improving data management.

Improve Directory Data and Management: CAQH ProView aims to enhance the accuracy and management of health plan directories by utilizing data entered and confirmed by practitioners in the Provider Data Portal. The vendor claims that the solution eliminates redundant processes, potentially improving directory accuracy, and helping organizations meet regulatory requirements.

Provider Data Portal: The product includes a Provider Data Portal where practitioners can enter and update their professional information. According to the vendor, the portal allows providers to designate which health plans can access their information, potentially saving time and ensuring data quality for payers.

Credentialing Suite: CAQH ProView offers a comprehensive Credentialing Suite that aims to enhance data quality, network management, and regulatory compliance. Providers and group administrators enter data once, which is shared with all designated health plans. The suite automates primary source verification and continuously monitors for sanctions, potentially supporting efficient network management.

Primary Source Verification: According to the vendor, CAQH ProView's Primary Source Verification solution validates credentialing information using live data from authoritative sources such as licensing boards and medical schools. The product aims to automate manual processes, simplify verification, and potentially deliver greater accuracy, speed, and control to health plans.

Sanctions Monitoring: CAQH ProView's Sanctions Monitoring feature continuously checks for disciplinary actions and flags providers with sanctions on health plan rosters. The vendor claims that this feature enhances network management and regulatory compliance, with average notification times of 4.5 days and compliance with NCQA factors for delegation agreements.

Directory Management Solution: CAQH ProView's Directory Management Solution aims to improve health plan directories and reduce redundant processes. The product applies advanced analytics to physician-entered data, potentially enhancing data quality, reducing provider burden, and supporting regulatory compliance. Group administrators can centrally manage non-sensitive directory information and make changes once for all providers.

Improved Data Accuracy: The vendor states that CAQH ProView leverages practitioner-entered and confirmed information to improve data accuracy. The solution applies advanced analytics to ensure data quality, reduce errors, and potentially help organizations provide more accurate and complete directories to their members. Improved data accuracy may support better decision-making and enhance member satisfaction.