CAQH

• Professional License: Licenses are organized by state in this section. 
• Open each state by clicking “Edit” and confirm you are currently practicing by selecting “Yes.” 
• Update your license number and expiration date if not listed correctly. 
• Delete any states that are no longer accurate. 
• If you don’t have a license number, use your IBCLC or CLC certification number. Each license will auto-populate with “PTNL,” which means “provider type not listed,” or your license type, matching what you selected in Part 1. 
• Similar to the Personal Information section, every time you add a new Practice Location and that Practice Location is in a different state than where you live, you will need to come back to the Professional IDs seciton add that state by clicking “+Add.”

EDUCATION & PROFESSIONAL TRAINING:
Include any relevant degrees, schooling, internships, or professional training programs you have completed. Providing more complete educational information may help support future credentialing and insurance contract requests.

SPECIALTIES:

• Primary Specialty: If you a lactation provider, select “Lactation Consultant” when available, either RN or non-RN. Or, select your other primary specialty.
• Name of Certifying Board: If you are a lactation provider, choose “other, not listed.”
• Certifications: If you already acknowledged board certification under Primary Specialty, it’s not necessary to repeat it again in the Certifications section.
• Do you wish to be listed in the directory under this primary specialty?: Select “yes” for all three payer types – HMO, PPO, POS.

PRACTICE LOCATIONS: You must add at least one practice location. To create a new location, click the blue “+Add location” button box on the right side. To edit an existing location, click the pencil icon on the corresponding line.

Each practice location has three pages – Practice Details, Provider at the Location, and Services and Resources. Make sure to complete all three by clicking the “Save and Continue” button at the end of each page.

• Page 1 – Practice Details
  • Practice Location Name: Enter your company or your DBA name. Use your personal name if no company exists.
  • Virtual-Only Location and Location Address: If your practice is fully virtual, selecting the virtual checkbox will remove the Location Address section. If you provide both virtual and in-person services, leave the virtual checkbox unchecked and enter the work address you want to be displayed in insurance directories. If you don’t have a separate work address, it’s acceptable to use your home address.
  • Digital Directory Information: This information will be published online in insurance directories. Include your domain email if you have one, your website under “Practice Location Website,” and your website again under “Appointment Scheduling Website,” even if you don’t have a formal scheduling calendar. A contact form will suffice for scheduling. Then add the phone number patients should use to schedule an appointment.
  • Business Identifiers:
    • Tax ID: If you have an Employer Identification Number (EIN), input that. If you do not, use your Social Security Number (SSN).
    • Type of Tax ID: Select “Individual” if you do not work with any other providers at that Tax ID; select “Group” if you work with other providers.
    • Organization (Type 2) NPI: If you selected “Group” for Type of Tax ID, an additional field for Type 2 NPI will appear. If you need assistance creating a Type 2 NPI, refer to the second half of our NPI instructions – https://lactationbilling.com/npi/.
    • Type of Practice: Select “Individual” if you work on your own. Select “Single-Specialty Group” if your practice includes the same type of providers as you are. Select “Multi-Specialty Group” if you work with other types of providers (including both nurse and non-nurse RNs together).
• Page 2 – Provider at the Location
  • Affiliation:
    • Please describe your affiliation with this location: Select “I see patients by appointment at least one day per week on a regular basis.”
    • Provider’s Start Date: Use the date you began practicing at this location.
    • Is this your primary practice?: You can only designate one location as your primary practice. Generally, your primary is the one that you own or work at most frequently.
    • Specialty: The only options available in the section will be the ones you selected in the main Specialties section of your CAQH. Mark that as selected.
    • Provider Directory Classification: Select “Specialist.”
    • Will you continue to practice at this location?: Select Yes.
  • Patients: Read through these questions carefully and answer honestly. Some questions may vary by the provider’s home state. Generally the answer to all questions is “Yes” except “Does the above information vary by health plan?” For this question, you will likely want to answer “No.”
• Page 3 – Services and Resources
  • Telehealth: If you provide telehealth services, select “Audio/Video” for the telehealth type. Audio-only services are often insufficient for lactation reimbursement.
  • Payment and Remittance:
    • Billing Policies: Check off both “This practice offers Electronic Billing” and “The office manager and payee contact are the same person.” Even if you work with a separate office manager, bookkeeper, or billing company, keeping one primary business contact in CAQH often simplifies account management and credentialing communiciation.
  • Office Personnel:
    • Office Manager/Business Staff Contact: Add your primary CAQH contact here; for most of you, you will add your own info. How you operate inside of your business can be different.
    • Check off both “The office manager is also the credentialing contact” and “The office manager and billing contact are same” when you choose one single business contact for CAQH.
  • Mailing Address: If your mailing address is different from your other addresses in this location, click “+Add” button and add the mailing address. If LCB is managing your billing and credentialing, ensure your mailing address information matches the information LCB has on file for you.
  • Phone Coverage:
    • Phone Coverage Type: If you have a voicemail or answering service that takes messages for your practice, select that in the dropdown.

HOSPITAL AFFILIATIONS: If you do not have hospital admitting privileges, skip this section. 

CREDENTIALING CONTACTS: This section identifies the person responsible for managing your insurance credentialing, in-network contracting, and provider enrollment applications.

If LCB is managing your credentialing, input the following as your credentialing contact:

Charlotte Stellan, 13 Fox Chase Rd, Columbia, SC 29223, assistant@lactationbilling.com, 203-614-9030 (phone), 310-872-1533 (fax)

• Primary Credentialing Contact: You can only have one primary credentialing. If you are involved in multiple group contracts, you must thoughtfully decide which one to select.
• Location Type: Select “Practice Location.”
• Location: After selecting “Practice Location,” a new field will prompt you to select your company name(s).

PROFESSIONAL LIABILITY INSURANCE: To input a policy for the first time, click the “+Add” button, and fill in all required fields. Make sure you select all locations covered by the policy. Generally, if you work as a 1099 contractor, you will need to add each company you own or work for as an “Additional” or “Secondary” insured on your individual policy for coverage to be effective. If you work for another company or group practice as an employee, you may have to obtain a copy of the Certificate of Insurance (COI) from that organization in order to complete this section out correctly. If you work for yourself, these are likely answers to the following questions:

• Do you have unlimited coverage with this insurance carrier? – No
• Individual Coverage – Yes
• Self Insured – Yes

EMPLOYMENT INFORMATION: You don’t need to include your entire work history. CAQH is looking for ten years of work history in your specialty and wants explanations of gaps in your work history. If your specialty-related work history is less than ten years, it is appropriate to begin with your earliest relevant professional licensure or certification date as a healthcare professional.

PROFESSIONAL REFERENCES: Add at least two references even though this section may not display a required red asterisk. If you are an LCB client, it’s fine to use Nicole as a reference – Nicole Peluso, nicole@lactationbilling.com, 323-595-4006. Based on our experience, CAQH professional references are rarely contacted directly.

DISCLOSURES: Some disclosure questions vary by state. If you see multiple tabs above the word “Disclosure,” answer the questions in each tab before continuing.

AUTHORIZE: 

• The “Authorize” button is the last button in the top navigation all the way to the right side.
• There are two tabs in this section. First, go to “Organizations” in the left menu. Choose “Authorize” so that insurance companies can view the information in your CAQH profile when they request to view it.
• Second, go to the “Authorization Setting” tab and select “Yes. Release my data to any organization that requests access.” 
• Click on the “I hereby authorize…” statement, and then click the “Save” button.

DOCUMENTS: The “Documents” button is the third option in the top navigation. 

• Upload your certificate of liability insurance as an attachment in this section, even though you’ve already inputted the data from your liability policy earlier in the application. 
• Sometimes an individual state or an insurance company will request you sign additional document(s). If prompted to do so, please download, sign, scan, and upload them as well.

REVIEW & ATTEST: 

• Click the red “Review & Attest” button in the upper right side of the screen. 
• Scroll and read through the attestation text. 
• Click on the “View Your Data Summary” button to download a PDF copy of your CAQH profile which you may need to send to your credentialing team. 
• Click on the red “Attest” button to complete your CAQH process. If the CAQH system identifies incomplete or incorrect sections, it may ask you to fix certain sections before attestation can be finalized. Once you have completed the fixes, press the red “Attest” button again to finish the process.