Panicked about CAQH rebranding to DataSpring and ownership by the major insurers? While it’s definitely alarming, I think it’s important to provide some context about CAQH. What access did CAQH have to your information before? What were its other ventures and ways of making money? Knowing that will help us look to the future and address concerns around the consolidation into for-profit status and possible future tightening of insurer control.
A Brief History of CAQH
CAQH was begun back in 2000 as a coalition of insurers, who founded it as the Council for Affordable Quality Healthcare (CAQH). (“affordable” and “quality” being terms I’m not going to attempt to define!)
Their original goal was to consolidate and streamline required administrative processes such as credentialing and standardizing electronic data interchange (EDI). The EDI portion is known as CAQH CORE: Committee on Operating Rules for Information Exchange and doesn’t directly affect professionals in practice operations.
I remember with no fondness the days of filling essentially the same paper form out for each insurer, then standing in line at the post office to mail them out. Unless you happened to practice in a state that mandated the same form for each insurer, there was no alternative but to fill out another variation of the same provider credentialing application each time you wanted to apply to a panel – and each time you were up for recredentialing.
What access did CAQH have to your information before DataSpring?
In 2002, CAQH launched what they called the Universal Provider Datasource – one online repository of healthcare professional data for any insurance company to download (not just behavioral health – all medical specialties!) For a fee, naturally. In 2015, the Universal Provider Datasource was redesigned and rebranded as CAQH ProView.
Which means that since 2002, just about any insurer who wants to obtain your credentialing data has had access to it through some version of the CAQH portal we’re familiar with today. Click here for CAQH’s 2019 annual report, which contains 4 pages of insurers and related entities who are either members or participants in CAQH. In about a 4-point font, 4 columns per page!
If you no longer have a copy of the CAQH release of information you had to sign to create your ProView account, re-read it here. I suggest you first grab a magnifying glass, because it’s also in what looks to be a 4-point font. It doesn’t protect you and/or your data at all. Never did. I suspect most clinicians never read it, for the simple reason that if you don’t sign it, you don’t obtain a ProView account. No ProView account means no joining an insurance panel. There was never a choice in the matter. Even during the not-for-profit days.
25 years of CAQH’s other ventures and ways of making money
Being “not-for-profit” doesn’t mean an organization is destitute or operates on a shoestring. It simply means that for tax purposes, any money earned is either re-invested back into the enterprise, or is used for charitable/community ventures.
In 2025, CAQH’s revenue was about $20.2 million and the organization was valued at over $60 million. They’ve always derived revenue from services sold directly back to the insurance industry who created them:
- A database tracking all license board & governmental provider sanctions.
- A primary source verification tool for insurers or other entities (hospitals, the venture-capital platforms) to use during credentialing. In other words, AFTER you complete your ProView profile, the person with access to all your information can then easily query “primary sources” – such as your state’s license board, Drug Enforcement Agency (for prescribers), the National Practitioner Data Bank, etc., with the click of a mouse.
- A database insurance companies use for Coordination of Benefits. When you get a clawback for services that took place over a year ago, saying “so sorry for the inconvenience but this other insurer was primary,” they’re getting the other plan information from CAQH, now DataSpring. It’s only within the last 12 months that clearinghouses available to the provider community, such as Office Ally, have implemented the same technology into their offerings.
NO, I don’t know how they can legally get that COB tool past HIPAA. I really don’t.
So at least, it seems more honest that CAQH has finally openly admitted to being for-profit. Why not? Extracting money from healthcare and related activities is hardly a new concept – in fact, it’s the “great” American way.
Furthermore, CAQH’s board members have always been high-level executives at the various large insurance payers. The current board has representation from: United Healthcare, Centene, Humana, Aetna/CVS, Cigna, Elevance/Anthem BCBS, and Horizon BCBS (who stands for all other Blues).
Looking to the Future
So what’s the change, aside from the name? I don’t believe the name change to DataSpring means much. It’s just a name. The bigger issue is the shift, in January 2026, from a non-profit entity to a for-profit corporation.
Now that DataSpring is for-profit, their obligation will be to generate revenue for shareholders – who are the health plans.
At some point, will ProView require a paid subscription from underpaid healthcare professionals? It certainly seems as though any entity that interfaces between insurance payers and healthcare professionals eventually tries to get a financial cut. An example are payment intermediaries such as Zelis or ECHO, who capture revenue by means of virtual credit cards and/or fee-based electronic funds transfer.
The aggregated information collected and controlled by DataSpring isn’t limited to clinicians, either. Because one of their offerings is the Coordination of Benefits Database, member information is stored here as well.
These numbers are a frightening look into the centralization of information under the ownership of the very entities who make both healthcare professional credentialing / contracting decisions, AND also health insurance coverage decisions. Conflict of interest, anyone?
I can’t predict what’s to come, but if you’re encountering any difficulty with paneling, depaneling, or with claim denials, I can help. And while I don’t believe there’s cause for immediate panic, given that this information repository has existed for decades, I do believe that guardrails, guidelines, and enforcement mechanisms need to be established – sooner rather than later. The insurance payer owners of DataSpring clearly have a vast amount of power, which has the potential to be utilized in coercive ways.
What can an individual clinician or member of the public do? Individually, possibly not a lot. But we can start by educating: our clients, their employers, the media, our elected officials. Bringing attention to the nature of the issue and utilizing our voices to suggest fair solutions that benefit everyone is clearly the most immediate first priority.
