The CAQH standardized application is an online form that meets the needs of all participating health care organizations. When completing the application, you will need to indicate which participating health plans and health care organizations you authorize to access your application data. All provider data you submit through ProView maintained by CAQH in a secure, state-of-the-art data center. When you are ready to begin entering your data, log in to CAQH ProView with your user name and password.
The following materials are helpful to reference while applying:
- Previously completed credentialing application
- List of previous and current practice locations
- Various identification numbers (UPIN, NPI, Medicare, Medicaid, etc.)
- State medical license(s)
- Drug Enforcement Administration (DEA) Certificate
- IRS Form W-9(s)
- Malpractice insurance face sheet
- Summary of any pending or settled malpractice cases
- Curriculum Vitae
After completing the online credentialing application, you will also be asked to:
- Authorize access to your information — List the organizations that you would like to receive your information. You may select "BCBSMT" or "global authorization."
- Verify your data entry/Attest — Review the summary of your data for accuracy and completeness, and make any necessary changes.
- Upload supporting documents — Fax the applicable documents required to complete your application to CAQH at 866-293-0414.
- State medical license(s)
- Drug Enforcement Administration (DEA) Certificate
- Malpractice insurance face sheet with provider's individual name listed
- Summary of any pending or settled malpractice case(s)
- Signed Attestation (page 18 of online application — print and sign)
Additional Information Required by BCBSMT for Credentialing
Physicians (MDs and DOs): If you do not have current admitting privileges, provide a formal letter signed by the physician or a physicians group who have agreed to admit and care for your patients as necessary is required. Admitting physicians must be the same specialty, located in the practicing physician's community, and provide 24/7 coverage.
At recredentialing physicians must attest to having completed 75 Category I CME in the previous 3 years.
If you have any questions on accessing the CAQH ProView, you may contact the CAQH Help Desk at 888-599-1771 or providerhelp@solutions.caqh.org for assistance.
Note: BCBSMT may contact you to supplement, clarify or confirm certain responses on your application. Therefore, you may be required to submit additional documentation in some situations, in addition to the information you submit through the CAQH ProView database.