Does Medicare use CAQH?

This is a question often asked by our clients and we figured it would be useful just to publish a quick  post to clear up any confusion.  CAQH is used primarily by commercial insurance companies like BCBS, Aetna, UHC, Cigna, and others.  CAQH is used by some states to aid in Medicaid enrollment but that is certainly an exception rather than a rule. Medicare is administered by numerous different carriers such as Novitas, First Coast Service Options, Palmetto GBA, WPS, Highmark, etc., and each of these carriers has to bid every 3-5 years in order to keep their government contract.  Because of the competitive bidding process, it is imperative that they keep their costs very low which is why none of them at the date of writing this post utilize CAQH.

 

CAQH is simply a repository of information which means that you or someone in your office could use CAQH to aid in the completion of Medicare applications but you would still need to actually complete the information.  CAQH is a great time saver if used as a storage place for important documents and information but does not do any of the actual credentialing or contracting for providers interested in participating with Medicare or any of the commercial insurance agencies.  Credentialing involves primary source verification which must be completed by each organization including Medicare each time you request to participate.

 

To restate, Medicare does not use CAQH but you can use the information stored in CAQH (If updated with your current information) to aid in the completion of Medicare enrollment applications.  For more information about Medicare enrollment or to download Medicare applications, visit MedicareApplications.com