Printable blank CAQH Provider Application

Fill Out Form
  • No Pens
  • No Paper
  • No Scanners
  • No Printers

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;
  • Education/Training;
  • 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. 

Hear What PDFLiner Users Have to Say & Join Them Today

  • Fred Walters
    Entrepreneur
    Now that I’ve switched from Word to PDFLiner, I save lots of time processing and digitally distributing tons of billing forms, work orders, forecast reports, and invoices. In addition to this, thanks to PDFLiner, we’ve significantly minimized our paper consumption. Excellent tool that helps me cope with my business workflow faster and easier.
  • Peter Scheffel
    Self-employed attorney
    PDFLiner allows me to streamline the processes of generating and managing legal documents, as well as collecting electronic signatures for all my contracts and agreements. I like that I can customize forms on the go and access PDFLiner from all my gadgets. No more printing or scanning! That’s just brilliant!
  • Lisa Matthews
    University student
    When you’re a student, you deal with PDFs a lot… Newsletters, various worksheets, official forms you need to fill in and sign, etc… To me, filling out a PDF form used to be among the trickiest and most time-consuming things ever. But then a friend of mine introduced me to PDFLiner, and oh my God, my life has changed since then. It’s easy to use and has so many great features. Just awesome, I love it!
Please, wait...