Document Submission, Acceptance, and Validation Process CAQH ProView™ Document Submission, Acceptance, and Validation Process

Document Check List 1. Check Your Documents Professional Liability Insurance: Includes name of insured provider Letter of Self Insurance/No Insurance: If created by the provider includes: Wet Signature Date of Signature Practice Location Address and Phone Number reason and letterhead are encouraged, but not required If created by legal department or self-insurance entity: 2. Check the Professional Liability Insurance section of the Portal The Expiration Date on the profile matches the Professional Liability Insurance document The Policy Number on the profile matches the Professional Liability Insurance document The provider name on the profile matches the Professional Liability Insurance document

Document Check List Answer: “Are you covered under a Professional Liability Insurance Policy?” Yes -if you are uploading a Professional Liability Insurance document No-if you are uploading an explanation of no insurance or a letter of self-insurance 3. If emailing or mailing, prepare the Documents section of the portal An entry is created for each document you will be adding The right document type is selected Professional Liability Insurance document Letter of Self Insurance/No insurance 4. Add your documents Uploading via the Portal The document is in the correct format (PDF, TIF, JPG, or JPEG only) The document size is smaller than 12MB Each document is uploaded separately All documents are legible and no important details were cutoff during the scanning process

Document Check List Sending via email Specific CAQH Provider ID is included in the email subject Email cover sheet is in the body of the email and NOT an attachment Each attached document is smaller than 12KB The email address to send to is documents@proview.caqh.org Sending via US mail CAQH Provider ID is included on EACH document If sending copies, documents are legible and no details are cutoff or missing Mailing Address is: CAQH PO Box 696537 San Antonio, Texas 78269

Document Submission Guidelines General guidelines for submitting documents: To complete the data profile, providers must submit all required supporting documents. CAQH ProView does NOT support faxing of supporting documents. Providers may upload supporting documents via the portal account. Providers may send supporting documents via e-mail. Providers may send supporting documents via US Mail. All documents undergo a Quality Assurance (QA) review process. Purpose of QA is to ensure compliance with established CAQH ProView quality standards. Documents which are not required for credentialing will be rejected. Required documents will be listed on the provider CAQH ProView account. Documents that do not meet compliance and quality standards will be rejected. Typical turnaround time from submission to review and approval is one business day.

Document Acceptance Criteria – Upload, Email & US Mail Documents submitted by portal upload, e-mail, or US Mail MUST meet the following criteria for acceptance: Document Format – Documents are accepted in PDF, TIF, JPG, or JPEG formats. Document Size – All files must be smaller than 12MB. Document Type – Select the appropriate document name or document type when uploading documents. Supporting documents that do not have existing document types in the dropdown should NOT be uploaded as ‘Other’. Signature – Some documents such as the State Release forms require signature and the Provider must affix his/her wet signature. Electronic/digital signatures are not accepted on the Attestation Authorization and Release form. Signature date – The signature date, if required on the document, must be within 120 days of the current date. Only one Authorization, Attestation and Release needs to be submitted to ProView, once attested the electronic date stamp at the top of the Authorization, Attestation and Release extends the original wet signature. Provider Name – The name on the document must match the name entered on the profile. Ensure the supporting document/s are NOT expired. When scanning documents, ensure that each document is scanned and saved separately as ONE document. Each page must contain only ONE document type. Each document must be uploaded separately. Documents must be legible and no important details cutoff during the scanning process.

Document Acceptance Criteria – E-mail Documents submitted via e-mail MUST meet the following criteria: The e-mail address for submitting supporting documents is documents@proview.caqh.org. The e-mail coversheet must be in the body of the e-mail and should NOT be attached to the e-mail together with other documents. Copy and paste the table (on the coversheet) into the body of your email. The CAQH Provider ID number must be indicated in the body or subject line of your e-mail. Include document type per attachment and up to 10 attachments per e-mail. Each attached document must be smaller than 12MB. For Professional Liability Insurance documents, the face sheet must specifically name the provider as an insured OR if you are sending a group Professional Liability Insurance, it must include a provider specifically named as one of the providers covered by the insurance.

Document Acceptance Criteria – US Mail If submitting documents by US Mail: Mail your documents to: CAQH PO Box 696537 San Antonio, Texas 78269 The CAQH Provider ID number MUST be indicated on each document. PMs sending multiple documents for multiple Providers MUST clearly indicate the CAQH Provider ID number on each document. If sending duplicate copies of documents (not the original ones) or printed from online websites, ensure the copy is legible and no important details are cut-off or missing. For Professional Liability Insurance documents, the face sheet must specifically name the provider as an insured OR if you are sending a group Professional Liability Insurance, it must include a provider specifically named as one of the providers covered by the insurance. If you are sending multiple documents through US mail, these documents will initially be uploaded as 'Other'. You may receive an e-mail notifying you that the documents failed. However, that occurs during the splitting process to separate documents. If all documents are valid, they will be posted using the correct document type. You may log in to your account within 2-3 business days to check status of the documents.

Document Statuses Following are the statuses you may see in the Documents section. Missing – required documents will appear as missing if you have not yet uploaded a document. Required documents include Application Release, State Release, and State Authorization forms. Conditional documents will appear as Missing depending on the information entered in the profile data (e.g., If a provider has indicated he/she has a DEA, the Documents section will show a DEA slot marked with a red asterisk and a status of Missing. If the provider has indicated he/she has professional liability insurance and has not uploaded a Professional Liability Insurance document yet, it will appear as Missing in the Documents section) Received – a document which has recently been uploaded on the portal will show as Received. The document will remain in this status until the validation is complete Failed – the status of a document which did not pass the validation process Approved – the status of a document which has passed the validation process Expired – documents such as DEA, State License, CDS, Professional Liability Insurance etc. with an expiration date that is in the past (i.e., expiration date < current date)

Professional Liability Insurance Validation – Policy Number Match Following are the validation rules for Professional Liability Insurance approval: Details on the Professional Liability Insurance document such as the Policy Number, Expiration Date, and the Provider Name MUST MATCH the details entered in the profile. Policy Number If the Professional Liability Insurance document shows Self-Insured, Self-Insurance, or N/A as the policy number, enter the same (Self-Insured, Self-Insurance, or N/A whichever is applicable) on the Provider's profile If the Professional Liability Insurance document does NOT include a policy number, you may enter either N/A or None If the document is showing a Master Policy ID and a Policy ID, enter the Master Policy ID number in the Policy Number field ACORD forms which include a CGL (Commercial General Liability), Umbrella, Worker's Compensation and Employers' Liability, use the CGL number as the Policy Number For FTCA documents, you may enter 'FTCA' in the Policy Number field

Professional Liability Insurance Validation – Expiration Date Match The Expiration Date on the Professional Liability Insurance document MUST exactly match the Expiration Date of the Professional Liability Insurance record in the profile. Expiration Dates *Professional Liability Insurance documents with automatic renewal/infinite expiration dates - Every Professional Liability Insurance record and document in CAQH ProView should have a shelf-life of 1 year - If a face sheet has an expiration date of “unlimited”, enter an expiration date of one year from the date the document was uploaded or the date the document was sent for e-mailed or mailed documents - The Provider is required to renew this policy each year and upload a corresponding document each year (it may be the same document but it needs to be re-uploaded for the renewed record) *Professional Liability Insurance with effective date that is in the future - If the effective date of the Professional Liability Insurance document is in the future, it will be accepted ONLY IF there is another face sheet that covers the current period. Enter the effective and expiration dates showing on the document. - However, if this is a brand new provider with no coverage, the Provider should upload a Letter of Self-Insurance or Explanation of No Insurance; he/she should first change the answer to the Professional Liability Insurance question from "Yes" to "No". *Non-standard FTCA documents - Providers are recommended to submit a short, dated letter on letterhead that states that the Provider/group is covered by the Federal Tort Claims Act (the letter should be attached as part of or in lieu of PLI, not a separate document). - The expiration date should be one year from the date of the letter

Professional Liability Insurance Validation – Provider Name Match The Provider name MUST be included on the Professional Liability Insurance document and match the name in the profile. Provider's Name *Group PLI - Professional Liability Insurance documents that include a face sheet and a list of Providers covered by the insurance are accepted as long as the Provider's name is on the list. - Professional Liability Insurance documents where the names of each of the Providers appear on each of the pages should be scanned and uploaded separately. ONLY the page that applies to the Provider should be uploaded and accepted on the profile. *FTCA documents - An FTCA document without the Provider's name will be accepted provided that the practice location address on the document matches the practice location address listed in the Provider profile. *If the Professional Liability Insurance Document does NOT contain the Provider name, the Provider or PM may: - obtain a copy of the Professional Liability Insurance document that includes the Provider name; or - create a letter stating the name/names of the insured Provider; handwritten letters may be accepted ONLY IF they are written on letterhead. Note: In this scenario, the Professional Liability Insurance should be scanned and uploaded together with the letter for the document to be accepted. *If the Provider has handwritten his/her name on the Professional Liability Insurance as insured, the document will NOT be accepted. *Providers whose Professional Liability Insurance document shows practice location as insured and includes his name and Provider Type as well (e.g., Cristina Dipay MD DBA Friendship Clinic), the Professional Liability Insurance will be accepted. In this scenario, the Provider should NOT update his/her name on the profile to match the one showing on the document. Hyphenated names on portal/Professional Liability Insurance must match – Request Provider to obtain updated Professional Liability Insurance to match the portal or to update portal to match PLI.

Professional Liability Insurance Validation – Compliance Match Other validation criteria Compliance The Provider selected No to the question "Are you covered under a Professional Liability Insurance policy?" when it should be Yes or, vice versa. - If the Provider is uploading a Professional Liability Insurance document, the answer to the question "Are you covered under a Professional Liability Insurance policy?" should be Yes. - If the Provider is uploading an explanation of no insurance or a letter of self-insurance, the answer to the question "Are you covered under a Professional Liability Insurance policy?" should be No. The Provider did not renew an expired insurance record or did not add a new record prior to uploading or sending the Professional Liability Insurance document through e-mail or mail. - If the Provider needs to upload a renewed Professional Liability Insurance document, he/she needs to renew the expired Professional Liability Insurance record in the profile prior to uploading or submitting the document - If the Provider needs to upload a Professional Liability Insurance document for a new coverage, he/she needs to add the details in the profile prior to uploading or submitting the document Incorrect Document Type - Professional Liability Insurance documents should be uploaded as PLI. - Letter of Self-Insurance or Explanation of No Insurance documents should be uploaded as Letter of Self-Insurance or Explanation of No Insurance - Non-standard FTCA documents and the Certificate of Self-Insurance issued by the Treasury Department of the State of Tennessee should be uploaded as PLI. These documents require a short, dated letter on letterhead that states that the Provider/Group is covered by the Federal Tort Claims Act or by the Certificate of Self-Insurance

Letter of Self-Insurance or Explanation of No Insurance - Validation Validation criteria for approving Letter of Self-Insurance or Explanation of No Insurance: Provider Name – the name on the letter MUST match the name on the profile Wet Signature Letters of Self-Insurance/Explanation of No Insurance that require the Provider signature are those that are created by Providers. Those created by the legal department or self-insurance entities do not need to have the Provider signature, date of signature, Practice Location Address, and Phone Number. As long as the Provider name is indicated on the document and the document is uploaded in the portal, it will be accepted. The answer to the question “Are you covered under a Professional Liability Insurance policy?“ should be No. Document Type used when uploading Letters of Self-Insurance or Explanation of No Insurance should be uploaded as Letter of Self-Insurance or Explanation of No Insurance The following should also be included on the letter: practice location address, phone number, and the date of the signature. The reason for self-insurance or no insurance and the professional letterhead are not required but encouraged. Other forms that may be accepted in this slot: bank letters (bank statements will NOT be accepted) and State Funded and Military forms

Authorization Forms The authorization form can be used to gain access to a Provider’s account. The form should include ALL of the following elements for it to be accepted: Full name of the primary authorized contact and his/her contact information Full name of the secondary authorized contact (if applicable) and his/her contact information Printed name of the Provider Provider’s CAQH ID number Wet signature of the Provider Date of signature

Authorization Form Check List Authorization Form (send via email to providerhelp@proview.caqh.org): Full name of the primary authorized contact and his/her contact information Full name of the secondary authorized contact (if applicable) and his/her contact information Printed name of the Provider Provider’s CAQH ID number Wet signature of the Provider Date of signature