What is CAQH Attestation?

CAQH Attestation Definition

CAQH Attestation is a critical compliance heartbeat in the provider data lifecycle. For Payer and Health System Executives, this process represents the shift from passive data storage to active data stewardship. When a provider attests, they are legally certifying the validity of their licenses, malpractice insurance, and location data. Operationally, the "Attestation Gap" is a primary driver of onboarding friction. If a provider fails to attest within the 120 day window, their data is marked as "stale," and payers are often contractually or regulatorily prohibited from using that data for credentialing or directory updates. This creates a significant revenue risk, as a single missed attestation can halt the reimbursement cycle for an entire medical group. Advanced organizations use automated monitoring to alert providers 30 days before their attestation expires to ensure zero-gap continuity.

FAQs

What is the direct financial impact of a missed CAQH Attestation?

A missed attestation prevents payers from pulling updated credentials, which can lead to the suspension of a provider’s "in-network" status, resulting in claim denials and increased member out-of-pocket costs.

How does the No Surprises Act intersect with CAQH Attestation?

While CAQH is a primary data source, the No Surprises Act mandates that payers verify directory data quarterly. Attestation serves as the provider's legal verification of that data, but payers must still have a mechanism to ingest and audit this information to avoid regulatory fines.

Can a health system manage attestations for their providers?

While the provider or an authorized practice manager must physically perform the attestation, health systems often use roster management tools to track "Attestation Status" across their entire workforce to prevent administrative bottlenecks