Professional Initial Credentialing Set Up

The Council for Affordable Quality Healthcare (CAQH) implemented CAQH ProView as a next generation system replacing the Universal Provider Datasource (UPD) after over a decade of use. Highmark is proud to offer this preferred method of credentialing to our providers. For more information on CAQH, please visit their website.

Below are steps to follow to begin the initial credentialing process using CAQH Proview:

If you are an initial applicant with Highmark and are NOT currently participating in CAQH ProView

• Please visit https://proview.caqh.org/pr to obtain a CAQH ID and complete the application. The online solution will guide you through the process, which will take several hours to complete the first time (however, the application does not need to be completed all at one time). Helpful resources are available through links on the login page to help you initially navigate the system. Be sure to select Highmark as a plan authorized to receive your information.
• Please access the initial credentialing request form and complete the form by providing your most recent information. Please include your CAQH ID when completing this portion of the form.  CAQH is used for Credentialing purposes only and not to update Highmark provider data. Provider data changes can be made by visiting the provider portal or by using the Provider Information Management Forms section of the Provider Resource Center.
• After you submit your form successfully, Highmark will retain an electronic copy of your CAQH ProView profile in its database and will send you a confirmation email. Please allow up to 180 days for processing as mandated by NCQA.

If you are an initial applicant with Highmark already participating in CAQH Proview and have an ID

• Please visit https://proview.caqh.org/pr to review and re-attest to your application. Be sure to select Highmark as a plan authorized to receive your information.
• Please access the initial credentialing request form and complete the form by providing your most recent information. Please include your CAQH ID when completing this portion of the form. CAQH is used for Credentialing purposes only and not to update Highmark provider data. Provider data changes can be made by visiting the provider portal or by using the Provider Information Management Forms section of the Provider Resource Center.
• After you submit your form successfully, Highmark will retain an electronic copy of your CAQH ProView profile in its database and will send you a confirmation email. Please allow up to 180 days for processing as mandated by NCQA.

If you are an initial applicant with Highmark and practicing with an existing group/assignment account, you will no longer have to complete the Request for Addition to Existing Assignment Account Form. Highmark will utilize the information submitted on the CAQH application.

• When completing an Initial Credentialing request, initial applications will not be accepted if submitted greater than 12 weeks from the practitioner’s start date.

Providers who deliver care exclusively in an acute care hospital setting should complete the Facility-Based Provider Affirmation Statement.