CAQH ProView
Medicare PECOS
Which option is right for your practice?
The right choice depends on your practice size, volume, budget, and how much internal resources you want to dedicate to credentialing administration. Niyutsa Technologies offers a free consultation to help you assess which approach delivers the best outcome for your specific situation.
Understanding the decision
CAQH ProView and PECOS are the two central credential systems in US healthcare, but they serve entirely different payer segments. CAQH ProView is a centralized commercial credential database used by 1,000+ commercial insurance payers, Medicare Advantage plans, and hospital systems. PECOS (Provider Enrollment, Chain, and Ownership System) is CMS's Medicare-specific enrollment system used only for Medicare Part B enrollment.
CAQH ProView stores your credentials — licenses, DEA registration, board certifications, malpractice insurance, work history, education — in a central profile that authorized payers can access. When you apply for network participation with a commercial payer, the payer pulls your credentials from CAQH rather than requiring you to submit them separately. CAQH profiles require re-attestation every 120 days to remain active.
PECOS is a different type of system. Rather than a credential database, PECOS is the actual enrollment application system for Medicare Part B. Your Medicare enrollment application is submitted directly through PECOS, reviewed by your regional MAC contractor, and results in a PTAN (Provider Transaction Access Number) that enables Medicare billing. PECOS does not integrate with CAQH — Medicare has its own separate credentialing requirements and process.
CAQH ProView is required for credentialing with commercial payers including all major carriers (Aetna, BCBS, Cigna, UnitedHealthcare, Humana, and 990+ others). Every provider needing commercial payer enrollment must have a complete, current CAQH ProView profile with authorized payer access.
PECOS is required for Medicare Part B enrollment. Every provider who wants to bill Medicare for professional services must be enrolled through PECOS and receive a valid PTAN. Medicare Advantage plans have their own credentialing (often through CAQH) separate from PECOS enrollment.
Frequently asked questions
Do I need both CAQH and PECOS?
Yes, for most providers. CAQH ProView is required for commercial payer credentialing. PECOS is required for Medicare Part B enrollment. Both are required for providers who want to bill both commercial insurance and Medicare — which is essentially every practice serving general patient populations.
How often does CAQH need updating?
CAQH ProView requires re-attestation every 120 days to remain active. When attestation lapses, the profile is marked inactive and payers accessing it receive an inactive status response, which halts pending applications. We manage quarterly attestation as part of our credentialing maintenance service.
How often does PECOS need updating?
PECOS requires revalidation every 3–5 years depending on provider type. CMS notifies providers of upcoming revalidation deadlines approximately 6 months in advance. Missing a revalidation deadline results in Medicare enrollment deactivation and requires complete re-enrollment.
Can multiple people access my CAQH profile?
Yes. CAQH ProView allows providers to authorize designated representatives to manage their profile on their behalf. This is how our team maintains CAQH on behalf of clients — you grant us access as an authorized representative and we handle all ongoing maintenance.
What if my CAQH and PECOS information conflicts?
Information should match across both systems. Address changes, DEA renewals, malpractice policy updates, and other changes should be updated in both CAQH and PECOS. Our maintenance program includes consistency checks across both systems to prevent the information drift that causes payer development letters.
Still not sure which approach is right for you?
Our credentialing specialists can review your specific situation and recommend the most effective approach. Contact us for a free 30-minute consultation.