Credentialed. Contracted. Ready?
Treat these as separate questions before you describe yourself as in network.
Credentialing: the professional review.
Credentialing concerns professional qualifications and the information used to verify them. CAQH’s provider-data services support collecting professional information and primary-source verification. A data profile helps supply information for that work; it is not itself a participation agreement.
Contracting: the participation terms.
Contracting concerns the agreement governing participation in a payer’s network. Keep the agreement and its effective date separate from the status of the credentialing review. Do not infer that an application, a profile ID, or a completed review means every plan and practice location is active.
Four questions for the payer
- Is my credentialing review complete, and is anything still outstanding?
- Is the participation agreement fully executed?
- Which products, locations, and billing arrangements are included?
- What is the confirmed effective date, and where can I find written confirmation?
These are organizational prompts, not a universal sequence. A payer may coordinate steps differently or request additional enrollment information. Keep its written answers and the agreement in your secure business records.
Keep the information current.
CAQH now presents its services under DataSpring, powered by CAQH. Its clinician page describes maintaining professional information and sharing it with authorized plans. Follow the portal’s current requirements and each payer’s update instructions.
Primary sources & scope
The distinction and questions are an editorial framework for organizing payer conversations. CAQH’s portal does not replace payer confirmation or review of the actual contract. Participation terms, timelines, and requirements vary.
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