Credentialing & CAQH Review

Credentialing/CAQH Review:

Credentialing reviews will be completed quarterly. This will include a review of CAQH account and credentialing logs. Credentialing logs will be kept in the provider’s chart/folder, and updated each quarter when reviews take place.

If updates are needed, billing tech will complete necessary tasks at the time of the review. Provider will be contacted if necessary information/documents need to be obtained. If there are problems with credentialing/CAQH, team lead and directors will be notified to take action to resolve problems. ALL actions will be documented on the appropriate log, which will be located in provider’s chart/folder.

Credentialing review task will be added to support calendar each month, however credentialing review only needs to be completed quarterly. If task is not being completed that given month, a note will be added to that task appointment indicating when the review will take place.