Update your provider profile accurately with CAQH

June 24, 2020

As previously communicated in a Partners in Health Update article, AmeriHealth is committed to increasing accuracy of provider directories and is working with the Council for Affordable Quality Healthcare (CAQH) to continue to improve the experience of providers. This will help members find your practice in directories when seeking care. Your patients will have real-time access to updated and complete information. We want to remind you of the importance of accuracy when updating your profile.

Credentialing

Providers interested in becoming credentialed in New Jersey are strongly encouraged to first complete the CAQH online credentialing application: CAQH ProView®. However, AmeriHealth New Jersey will accept the New Jersey Universal Physician Credentialing application. To become credentialed in Pennsylvania, providers are required to complete CAQH ProView.

If your practice contracts with multiple health plans, the CAQH ProView online application minimizes the administrative work needed to fill out multiple, redundant, and time-consuming forms.

Quarterly attestation

Certain AmeriHealth providers will be prompted quarterly to update or confirm their practice’s information for use in the directory.

When making changes to your profile, please be mindful of these scenarios:

  • Removing/terminating a provider. If the practitioner is removed/terminated from a location erroneously and that is the only location he or she is linked to, it will terminate the practitioner from the AmeriHealth network. This will automatically generate letters to our members and cause undue disruption.
  • Duplicate records. Please review the NPI at the location level in your profile and reconfirm before indicating there is a duplicate record.

It is imperative that you review and confirm the accuracy of the changes made before you submit your attestation to avoid incorrect information displayed in our provider directories and to prevent any disruption to your practice.

You can prepare for your next attestation by reviewing the CAQH training video. Ensure you are submitting accurate directory information by using the CAQH Best Practice Checklist.

Demographic changes

Using CAQH to make directory changes does not replace general demographic change requests. If you have questions about demographic changes, please view our AmeriHealth New Jersey or AmeriHealth Pennsylvania Demographic Maintenance Guide.

If you need to update information other than your practice location, please use the procedures outlined on our dedicated webpage.

Learn more

CAQH

If you would like to learn more about how CAQH is used, visit the CAQH website.

AmeriHealth New Jersey

Providers who need assistance during the quarterly attestation process should contact their Provider Partnership Associate.

AmeriHealth Pennsylvania

Community providers who need assistance during the quarterly attestation process should complete a Provider Network Services Inquiry Request form. Integrated Delivery System (IDS) providers should call Provider Services at 1-800-275-2583.