Professional Credentialing

Providers can enroll in our health plan by registering with the Council for Affordable Quality Health Care (CAQH) and completing the Initial Credentialing Request Form.

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.

Complete the application to obtain a CAQH ID. The online solution will guide you through the process, which will take several hours to complete the first time (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.

Obtain a CAQH ID

• Under Provider Sign In, enter your username and password if registered, or select register now.
• Enter your CAQH Provider ID. (If you don't know it, call CAQH at 1-888-599-1771).
• Enter or update your information.
• Authorize Highmark to access your information electronically.

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.

Initial Credentialing Request Form

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 the National Committee for Quality Assurance (NCQA).

Review and re-attest to your most recent information on the CAQH Provider Data Portal. Be sure to select Highmark as a plan authorized to receive your information.

CAQH Provider Data Portal

2) Complete the Initial Credentialing Request Form

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.

Initial Credentialing Request Form

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 the National Committee for Quality Assurance (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 six weeks from the practitioner’s start date.

Providers who deliver care exclusively in an acute care hospital setting should complete the form below:

Facility-Based Provider Affirmation Statement

Additional Resources for Providers

• Provider Information Management (PIM) Glossary
• Highmark Provider Manual - See Chapter 3 for detailed information on Provider Network Participation.
• What to Expect During Initial Professional Credentialing
  
• What to Expect During Professional Recredentialing