No — Medicare does not use CAQH for credentialing. Medicare uses its own system, PECOS. CAQH is a credentialing database for commercial insurance companies, not Medicare. You can, however, use the information you have stored in CAQH to help complete your Medicare enrollment applications faster.
Here is the fuller picture, because this question comes up constantly.
What CAQH is for
CAQH is used by commercial payers — BCBS, Aetna, UnitedHealthcare, Cigna, and others — as a shared credentialing repository. A handful of state Medicaid programs use it to aid enrollment, but that is the exception, not the rule.
Medicare is administered through a set of regional carriers (Novitas, First Coast Service Options, Palmetto GBA, WPS, and others), and those carriers periodically re-bid to keep their government contracts. That competitive pressure keeps their costs lean — one reason Medicare credentialing has not run through CAQH. Instead, CMS runs its own enrollment system: PECOS (the Provider Enrollment, Chain, and Ownership System).
CAQH is a repository, not a credentialing service
It helps to remember what CAQH actually is: a place to store your information. You (or your staff) can use the data in your CAQH profile to help fill out Medicare applications, but CAQH does not do any credentialing or contracting for you. It is a time-saver as a storage place for documents and information — nothing more.
Credentialing itself requires primary source verification, which each organization — including Medicare — completes on its own every time you request to participate. You still have to complete the enrollment process with each payer you want to work with.
To be clear
Medicare does not use CAQH — but a well-maintained, current CAQH profile makes completing your Medicare (PECOS) applications easier, because your information is already organized in one place.
Helpful CMS resources:
- PECOS provider enrollment: cms.gov/medicare/enrollment-renewal/providers-suppliers
- PECOS login: pecos.cms.hhs.gov
Provider Enrollment Services handles both commercial credentialing (including CAQH) and Medicare enrollment through PECOS, in-house since 2008. Explore our CAQH credentialing services and Medicare provider enrollment services, or request a quote at (800) 406-4796.