CAQH hygiene is network hygiene.

CAQH ProView is the centralized credentialing database that most health plans and hospitals use as their primary source for provider background data. Licenses, DEA registrations, malpractice history, work history, hospital affiliations — all of it lives in CAQH, and most credentialing workflows start there. When CAQH data is current and complete, credentialing moves efficiently. When it's stale, everything downstream slows down.

CAQH requires providers to re-attest their information every 120 days. If a provider doesn't re-attest within that window, their profile gets flagged as inactive. Inactive profiles can't be used for credentialing without the provider first reactivating and updating them — which requires the provider to take action, and providers who are busy do not always prioritize this quickly.

How stale CAQH kills credentialing timelines

Here is the sequence that plays out in builds without an active CAQH management program:

Contracting executes a contract with a provider in month three of the build. The credentialing team opens a file for that provider and requests their CAQH profile. The profile is inactive — it has not been attested in seven months. The credentialing coordinator sends a notice to the provider asking them to re-attest. The provider is busy and doesn't respond for two weeks. The coordinator sends a follow-up. The provider re-attests in week three, but some of the information is out of date because their license renewed in the interim and they forgot to update it. Another week to fix the deficiencies.

Four weeks have been spent on administrative follow-up that could have been avoided if the provider's CAQH profile had been current before contracting started. Multiply that across 30 contracted providers and you have a meaningful portion of your credentialing timeline consumed by CAQH chase work.

The pre-contracting CAQH check

One of the easiest things a contracting team can do to accelerate the overall build timeline is run a CAQH profile check on every provider before they enter contract negotiation — not during credentialing, but before the contract conversation. If a provider's CAQH profile is inactive or significantly out of date, flag it during the contracting outreach and ask the provider to update it. Providers who are engaged in a contract conversation are more motivated to act on administrative requests than providers who receive a cold outreach from a credentialing department they have not interacted with.

This doesn't require any special access — you can check CAQH profile status through your plan's CAQH access credentials without pulling the full file. The check takes two minutes per provider. Done at the start of the outreach relationship, it saves weeks at the end of the credentialing workflow.

Building a CAQH maintenance calendar for your network

For an existing network, CAQH maintenance is a calendar problem. Every provider in your network has a CAQH profile with a re-attestation schedule. You should know, at any given time, which providers have re-attestations coming due in the next 60 days — and you should have a workflow for following up with providers who miss their re-attestation window before they hit inactive status.

• Export the re-attestation dates from your CAQH roster quarterly.
• Flag anyone due for re-attestation within 60 days.
• Send a courtesy notice 45 days out, a reminder 15 days out, and an escalation notice when they go past-due.
• Track response rates and escalate to a provider relations outreach for providers who consistently miss their attestation window.

This is not complex. It is largely administrative. The problem is that most organizations don't have anyone explicitly assigned to own this function — it falls in the gap between the credentialing team (who manages new files) and the network management team (who manages contracts).

CAQH maintenance isn't a credentialing function. It isn't a provider relations function. It's a network operations function — and if nobody owns it, nobody does it.

The recredentialing connection

NCQA standards require health plans to recredential participating providers every three years. Recredentialing workflows depend heavily on CAQH — a current CAQH profile makes recredentialing significantly faster. If you have been letting CAQH hygiene slide, your three-year recredentialing cycle will surface the problem in bulk: a large cohort of providers with stale profiles, all hitting your credentialing capacity at the same time.

A good CAQH maintenance program is the best preparation for a smooth recredentialing cycle. Keep the profiles current on an ongoing basis and the three-year review becomes an administrative confirmation rather than a remediation effort.