Printable blank CAQH Provider Application
What is the CAQH form?
CAQH stands for ‘Council for Affordable Quality Healthcare,’ a non-profit organization based in California. The form allows you to register as the provider.
What I need CAQH form for?
You need to apply for a provider in the following cases:
- To get access to your information to insurance companies;
- To make the provider’s information more efficient. It means that insurance companies can just go to the CAQH website and get all the needed information about you instead of calling your office to know the work history and copy the medical licenses.
Filling out CAQH form
The CAQH form is pretty long, about 17 pages with lots of blank fields. Here are some basic rules:
- Use only сapital letters;
- Use the cross to indicate the correct answer, not dot or any other sign.
- The form has several sections:
- Personal info along with your IDs;
- Professional/Medical specialty information;
- Practice location information;
- Hospital affiliations;
- Professional liability insurance carrier;
- Work history and several references from your employer;
- Questions concerning the information disclosure.
Also, on the bottom of the document, you’ll find Standard Authorization, Attestation and Release page. You need to read it very attentively and put a signature and the date at the end of the page. In addition, there are code lists and special boards.
Organizations that work with CAQH form
Council for Affordable Quality Healthcare.
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