Case Study: Improving Credentialing Efficiency through CAQH Attestation
Client: Client in Therapy, Counselling and Coaching
Location: Virginia, USA
Industry: Healthcare – Medical Billing and Credentialing
Key Focus: Provider Credentialing, Payer Enrollment, Revenue Cycle Management
Background
Client based out VA operates a large physician practice network with over 100+ providers in Therapy, Counselling and Coaching specialties. The organization faced delays in payer enrollments and disruptions in claims processing due to inconsistent provider credentialing updates.
Upon audit, it was found that a significant percentage of providers had outdated or unverified profiles on the CAQH ProView platform, and many lacked regular CAQH attestations.
Problem Statement
Delayed Payer Enrollments: New and existing providers were not getting enrolled on time due to expired CAQH attestations.
Claim Denials: Insurance payers rejected claims citing “non-credentialed provider” status.
Administrative Burden: The credentialing team had to perform repetitive data validation with payers due to outdated or unverified profiles.
Solution: Implementation of CAQH Attestation Monitoring System
Our specialized credentialing team implemented a structured CAQH attestation tracking system with the following steps:
Monthly Attestation Reminders sent to all providers.
Credentialing Dashboard to monitor each provider’s CAQH attestation status and expiration in a weekly contracting and credentialing grid log.
Training Sessions for providers on CAQH profile maintenance and its impact on credentialing.
Dedicated Credentialing Specialist assigned to proactively update and attest provider profiles.
Results
| Metric | Before | After |
|---|---|---|
| Average Payer Enrollment Time | 60–90 Days | 30 Days |
| Claim Denial Rate due to Credentialing Issues | 15% | 2% |
| Provider Attestation Compliance | 45% | 98% |
| Administrative Rework Hours | 30 hrs/month | 8 hrs/month |
Key Takeaways
Timely CAQH attestation is critical for maintaining active credentialing with payers.
Lack of attestation can directly affect cash flow due to claim denials and delays.
A proactive approach to CAQH profile management saves time, reduces errors, and accelerates revenue realization.
Conclusion
CAQH attestation is not just a routine administrative task—it's a strategic necessity for seamless provider credentialing and billing. ABC Health Group’s case highlights how simple process improvements in CAQH attestation tracking can result in significant revenue and operational efficiency gains.
