CAQH

The CAQH Universal Provider Datasource (UPD) service is the industry standard for collecting provider data used in credentialing, claims processing, quality assurance, emergency response, member services, such as directories and referrals, and more. By streamlining data collection electronically, UPD is reducing duplicative paperwork and millions of dollars of annual administrative costs for more than 700,000 physicians and other health professionals, as well as over 500 participating health plans, hospitals and healthcare organizations.

A single, standard online form is the centerpiece of the service. Providers in all 50 states and the District of Columbia are able to enter their information free of charge through an interview-style process. All data is stored in a secure, centralized database housed in the United States.

www.caqh.org

NPPES

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers and health plans. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. The Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers.

Click below to create or update your NPI number.

https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart

NPI Registry

The NPI Registry enables you to search for a provider's NPPES information. All information produced by the NPI Registry is provided in accordance with the NPPES Data Dissemination Notice. Information in the NPI Registry is updated daily. You may run simple queries to retrieve this read-only data. For example, users may search for a provider by the NPI number or Legal Business Name. There is no charge to use the NPI Registry.

https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

Articles

Ever-changing Credentialing Challenges - Connecticut Medicine, 8/2009

Credentialing - Avoid Common Pitfalls - VantagePoint Advisor, 7/2007