A free guide from Cima Consulting
CAQH and PECOS: what each one is, and which you need
The short answer: CAQH is the shared credentialing profile that commercial, Medicare Advantage and Medicaid managed care plans read when they credential you. PECOS is CMS's enrollment system for Original Medicare. They don't talk to each other: Medicare doesn't read your CAQH profile, and commercial plans don't enroll you through PECOS. Most clinicians who take insurance need both, with the same name, address, tax ID and NPI in each.
Updated October 27, 2026. From the team that credentials a licensed Texas outpatient program and its clinicians. Check CMS's and CAQH's current pages before you file.
CAQH and PECOS side by side
| CAQH (Provider Data Portal) | PECOS | |
|---|---|---|
| What it stands for | Council for Affordable Quality Healthcare, now operating as DataSpring, powered by CAQH | Provider Enrollment, Chain and Ownership System |
| Who runs it | An organization health plans formed to share administrative work (CAQH) | CMS, the federal Medicare agency (pecos.cms.hhs.gov) |
| What it does | Holds your credentialing profile: licenses, education, work history, malpractice, locations and disclosures | Enrolls you in Original Medicare so you can bill it, and reassigns your Medicare payments to a group |
| Who reads it | The plans you authorize: most commercial, Medicare Advantage and marketplace plans, and the Texas Medicaid managed care plans' shared verification organization | Medicare and its contractor (Novitas Solutions for Texas) |
| The form | The online profile at proview.caqh.org | The CMS-855I for a clinician (reassignment is now on it too); the CMS-855B for a group |
| Cost | Free for providers | No application fee for clinicians or their groups; institutional providers pay ($750 in 2026) |
| Upkeep | Re-attest at least every 120 days | Report changes, and revalidate every five years when CMS asks (42 CFR 424.515) |
| Sign-in | Your CAQH username; your CAQH Provider ID never changes | A CMS Identity & Access (I&A) account, the same one NPPES uses |
Which one you need
- Commercial plans only: CAQH, plus each plan's own application. Start with the CAQH ProView guide.
- Original Medicare: PECOS. CAQH doesn't count. LPCs and LMFTs have been able to enroll since January 1, 2024; see Medicare enrollment for counselors and MFTs.
- Medicare Advantage: usually both. The plan credentials you from CAQH, and most expect you to be enrolled in Medicare too.
- Texas Medicaid: neither one alone. You enroll with TMHP in PEMS, and the managed care plans then credential you from CAQH. LPCs and LMFTs must enroll in Medicare first; see how to become a Texas Medicaid provider.
The order to do them in
- NPI first. Get your NPI in NPPES, with the practice address you'll use everywhere. A group or PLLC gets its own organization NPI; see NPI Type 1 vs Type 2.
- CAQH and PECOS in the same week. Neither waits on the other. Build and attest CAQH, and file the CMS-855I in PECOS before your first Medicare client.
- Then each plan. Commercial and Medicare Advantage applications point to your CAQH ID; Texas Medicaid goes through TMHP.
Medicare's effective date for a clinician is the later of the date the contractor receives an application it approves and the date you first saw clients at that location, with up to 30 days of billing before that in limited circumstances (42 CFR 424.520 and 424.521). That's why PECOS goes in early, not after the first Medicare visit.
Keep them matching
A mismatch between CAQH, NPPES and PECOS (a suite number in one and not another, an old tax ID, a legal name spelled two ways) is one of the most common reasons applications stall. Updating one system never updates the others: change NPPES within 30 days of a change to your NPI information, change PECOS separately, and update and re-attest CAQH. Our step-by-step credentialing guide shows where each detail goes.
Want both done, and kept current?
We build and attest your CAQH profile for $350 per clinician, file Medicare enrollment in PECOS for $500 per clinician, and keep both current with upkeep at $99 per clinician a month.
Questions
Is CAQH the same as PECOS?
No. CAQH is a credentialing profile private plans read; PECOS is CMS's Medicare enrollment system. They're run by different organizations and don't share data.
Does Medicare use CAQH?
Original Medicare doesn't. You enroll in PECOS. Medicare Advantage plans are private plans and usually do credential from CAQH.
Do I need PECOS if I don't take Medicare?
Usually not for billing. But Texas Medicaid requires LPCs and LMFTs to enroll in Medicare before they enroll in Texas Medicaid, and Medicare Advantage plans generally expect Medicare enrollment.
Which costs money, CAQH or PECOS?
Neither, for a clinician. CAQH is free for providers, and CMS charges no Medicare application fee to clinicians or their groups. Institutional providers pay the CMS fee ($750 in 2026).
How often do I update them?
Re-attest CAQH at least every 120 days. In PECOS, report changes as they happen and revalidate when CMS asks, every five years.
Sources
- CAQH, Who we are; CAQH ProView (Provider Data Portal)
- CMS, PECOS, NPPES and Medicare enrollment resources
- 42 CFR 424.515 (revalidation), 424.520 and 424.521 (effective dates)
- Texas Association of Health Plans, Credentialing 101 (Medicaid plans' shared verification from CAQH)