Availity® Provider Portal Updates Versus CAQH® Updates
Posted October 6, 2020
Providers have the opportunity to update their provider data on the Availity Provider Portal . You can verify your information, make edits and updates, and then simply click the submit button. Availity automatically sends your updates to the directories within Availity for all payers you have a contract with and who are registered with Availity. This will help save time by eliminating the need to fill out multiple forms and faxing or emailing them to each health plan payer. You can download a report with all your updated information to send to other payers who do not use Availity.
Please note: Availity and the Blue Cross and Blue Shield of Illinois (BCBSIL) Provider Finder® are two different systems. If you need to change existing demographic information with BCBSIL, complete the Demographic Change Form . If you have completed a Demographic Change Form, you can check the status of your request by entering the case number you received in your confirmation email in our Case Status Checker . For more information, visit the Information Change Request page of our website.
Likewise, any updates you make in Availity, do not transfer over to the Council for Affordable Quality Healthcare, Inc (CAQH), including the CAQH ProViewTM. Neither CAQH nor BCBSIL will contact you to make sure your credentialing information is up to date. It is the responsibility of the provider to check their information on a regular basis.
All providers who require credentialing must complete an Illinois CAQH file . Make sure your CAQH is up-to-date prior to submitting a credentialing application. This will help lessen outstanding billing issues. If your CAQH profile is not complete, your onboarding form will be rejected/returned to the submitter. To check the status of your credentialing process, enter your National Provider Identifier (NPI) or state license number in our Credentialing Status Checker .
CAQH requires you to review and attest to your data once every six months. At the time you are scheduled for recredentialing, BCBSIL will send your name to CAQH to determine if you have already completed the ProView credentialing process. If so, we will be able to obtain current information from the ProView database to complete the recredentialing process without having to contact you. If a provider does not keep their credentialing up-to-date, the provider may be terminated for non-compliance.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.
CAQH is an independent third party not-for-profit collaborative alliance of the nation’s leading health plans and networks. The mission of CAQH is to improve health care access and quality for patients and reduce administrative requirements for physicians and other health care providers and their office staffs. CAQH is solely responsible for its products and services, including the ProView database.