About this Article
This document describes all the data fields that Medallion pulls into a provider's profile when a CAQH import is completed. It also covers important conditional logic — situations where certain fields will or will not be imported based on the provider's CAQH profile data, import type, organization configuration, and provider type.
ℹ️ Note: This document covers what Medallion's importer applies to a provider profile. CAQH's PDQS API exposes approximately 310 fields across all queries. For the full list of available CAQH fields that Medallion does not currently import, see the CAQH fields not imported by Medallion section at the bottom.
Overview
When a provider is imported via CAQH, Medallion queries the CAQH ProView (PDQS) system and maps the returned data onto the provider's Medallion profile. The import covers personal information, professional credentials, education, work history, insurance, hospital affiliations, and more.
⚠️ Important: Only data that exists and is filled out in the provider's CAQH profile will be imported. If a field is left blank in CAQH, it will not overwrite existing data on the Medallion profile.
How Import Behavior Varies
The data imported from CAQH is largely the same regardless of how the import is triggered. However, there are important differences in behavior and validation depending on several factors. This section explains those variations.
By Import Trigger: Auto-Triggered vs. Manual
CAQH imports can be triggered in two ways:
Auto-triggered imports: initiated automatically by Medallion as part of the credentialing or onboarding workflow.
Manual imports: initiated by an admin or provider clicking "Sync from CAQH" within the Medallion platform.
Key differences:
Attestation records are only created for auto-triggered imports. If an admin or provider manually syncs from CAQH, no attestation record is created on the profile. (See Section 20 for details.)
Document errors: During an auto-triggered import, if a document fails to download from CAQH (e.g., a board cert PDF or insurance certificate), the entire import is halted and flagged as an error. During a manual import, the system logs the document error but continues importing all other data.
SSN validation: SSN validation against CAQH is skipped for recurring auto-import runs. For all other import types, including manual syncs, the SSN is validated against the CAQH record.
By Import Scope: One-Off vs. Bulk
Imports can be performed for a single provider or in bulk.
Key differences:
The data pulled from CAQH is the same for both one-off and bulk imports. The same field mapping and processing pipeline runs for each provider regardless of batch size.
Bulk imports have separate batch-level tracking for overall status, but this does not affect which CAQH fields are pulled per provider.
By Organization Configuration
Certain import behaviors are controlled by organization-level settings:
FTCA Coverage: FTCA coverage data is only imported if the organization has the CAQH bulk import feature enabled. Organizations without this feature will not have FTCA data pulled in, even if the provider's CAQH profile has the FTCA flag set. (See Section 12 for details.)
Work History from Practice Locations: By default, active practice locations from CAQH are also imported as current work positions. For a small number of organizations this behavior is disabled. Practice locations are still imported separately (Section 17) for those organizations.
Home Address Fallback: For organizations with the home address fallback enabled, if a provider's CAQH home address is empty, their first active practice location address is used as a fallback. This is not universally active for all organizations.
By Provider Type / Profession
The same set of fields is imported for all provider types. However, certain fields are only relevant or populated for specific professions:
DEA Eligibility: Only providers with DEA-eligible professions (MD, DO, NP, PA, DDS, DMD, APRN, CNM, PMHNP, PhD) will have DEA eligibility evaluated. Providers with other profession types will have DEA-related fields left blank. (See Section 5 for details.)
License Type Correction: If a license type from CAQH does not map to a recognized Medallion license type, it defaults to the provider's profession type.
ECFMG Number: Only applies to providers with non-US education programs.
By User Type (Provider / Admin / Staff)
The data pulled from CAQH does not vary based on who triggers the import. Whether a provider, an organization admin, or Medallion staff initiates the sync, the same fields are imported and the same processing pipeline runs.
Fields Imported from CAQH
The following sections detail every field that is pulled from CAQH and applied to the Medallion provider profile. Unless otherwise noted, these fields are imported the same way regardless of import type, user type, or organization.
1. Personal & Demographic Information
First Name, Middle Name, Last Name, Suffix
Date of Birth
Social Security Number (SSN)
Gender
Race / Ethnicity (see conditions below)
US Citizenship Status
Birth City, Birth State, Birth Country
Primary Phone Number (cell phone from CAQH)
Secondary Contact Email (personal email from CAQH)
Languages Spoken
Conditions & Nuances:
Race & Ethnicity: Medallion populates three separate fields — a single race value, a multi-select race array, and an ethnicity value.
If the newer multi-select race/ethnicity field is populated in CAQH, all selected values are stored in the multi-select array; the first value is also stored in the single race field.
If only the older single-select ethnicity field is populated, that value is used for both the single and array race fields.
Hispanic/Latino is treated as an ethnicity, not a race, and is stored in a separate ethnicity field.
If the provider selects "Prefer Not to Say," race fields are left blank and ethnicity is not set.
SSN validation is skipped for recurring auto-imports. For all other import types, the SSN from CAQH is validated against the existing Medallion record.
Name fields are cleaned by removing extra whitespace during import.
2. Home Address
Street Address (Line 1 and Line 2)
City
State
Postal Code
Country
Conditions & Nuances:
For organizations with the home address fallback enabled: if the provider's CAQH home address is empty or incomplete, the first active practice location address is used as a fallback.
3. Mailing Address
Street Address (Line 1 and Line 2)
City
State
Postal Code
Country
This is imported as a separate address from the home address.
4. Professional Information
NPI Number
Profession / Provider Type (e.g., MD, DO, NP, PA, etc.)
Primary Taxonomy Code
Secondary Taxonomy Code
CAQH Attestation Date
Conditions & Nuances:
The profession type from CAQH is mapped to Medallion's standardized profession categories.
5. DEA & Prescribing Information
DEA Eligibility
Prescribing Status
Controlled Substances Handling Description (if applicable)
Conditions & Nuances:
DEA Eligibility requires two conditions: (1) the provider's profession must be DEA-eligible (MD, DO, NP, PA, DDS, DMD, APRN, CNM, PMHNP, PhD), AND (2) the provider must not have indicated "I don't have a DEA due to my provider type" in CAQH.
If the provider selected "Other" as their no-DEA reason, the explanation text they provided in CAQH is imported as the Controlled Substances Handling Description.
Prescribing Status is only set to active if the provider is both DEA-eligible AND has indicated a DEA certificate is available in CAQH.
6. Collaborative Physicians
First Name
Last Name
Imported if the provider has alternate/collaborative prescriber information in their CAQH profile.
Conditions & Nuances:
The "Has Collaborative Agreements" flag is also set based on whether this data exists in CAQH.
7. Licenses
Three types of licenses are imported from CAQH:
State Licenses:
License Number, License Type, State, Status, Expiration Date, Issue Date
DEA Registrations:
DEA Number, State, Expiration Date, Issue Date
State Controlled Substance (CDS) Registrations:
CDS Number, State, Status, Expiration Date, Issue Date
Conditions & Nuances:
If a license type from CAQH doesn't map to a recognized Medallion license type, it defaults to the provider's profession type.
DEA and CDS registrations with an expiration date in the past are automatically marked as inactive.
DEA registrations default to active status unless the expiration date check overrides it.
8. Board Certifications
Certifying Board Name
Specialty Name
Certification Number
Expiration Date
Associated Document (board certification document — primary specialty only)
Conditions & Nuances:
Board certifications are only imported if the provider has indicated they are board certified in CAQH for that specialty.
Both primary and secondary specialty board certifications are imported if present.
A board certification document is only attached to the primary specialty record. Secondary specialty board cert records are imported without a linked document even if a document exists in CAQH.
If no board certification is indicated, the "Certifications" section is marked as skippable.
9. Education & Training
The following education and training program types are imported:
Undergraduate School
Professional School (Medical/Dental/etc.)
Non-US School (International Medical Graduates)
Fifth Pathway Graduate School
Internships
Residencies
Fellowships
ℹ️ Note: "Other Training" records are fetched from CAQH but are intentionally not applied to the Medallion provider profile.
For each program, the following fields are imported:
Institution Name
Degree Earned (where applicable)
Specialty (for residencies, fellowships, internships)
Start Date and End Date
Program Completion Status
Institution Address (Street, City, State, Postal Code, Country)
Conditions & Nuances:
If a program is marked as not completed, the incompletion reason is automatically set to "Other."
For Undergraduate and Fifth Pathway Graduate schools: if the end date is missing but the program is marked as completed and has a completion date, the completion date is used as the end date.
ECFMG Number: If the provider has an ECFMG number in CAQH, it is applied to all non-US education programs. It is not applied to US-based programs.
US Graduated Status: If any of the provider's Professional Schools or Fifth Pathway schools have a US address, the provider is flagged as US-graduated.
10. Work & Employment History
From CAQH Employment Information:
Employer Name, Job Title, Current Employer Flag, Start Date, End Date, Employer Address
From Active Practice Locations (converted to current positions):
Practice/Organization Name, Start Date, Practice Address
Conditions & Nuances:
Active practice locations are imported as current work positions by default.
If the practice location data cannot be parsed, the error is logged but will not block the rest of the import.
For organizations with the practice-location-to-work-history conversion disabled, employment history is still imported, but active practice locations are not duplicated as work history entries. Practice locations are still imported separately (see Section 17).
11. Malpractice Insurance
Medallion imports a subset of the malpractice insurance fields available in CAQH:
Carrier Name
Policy Number
Aggregate Coverage Amount
Per-Occurrence Coverage Amount
Effective Date
Expiration Date
Associated Certificate of Insurance Document
Conditions & Nuances:
Only the most recent, unique records with all required fields present are kept.
Certificate of Insurance documents are matched to insurance records by expiration date. If multiple records share the same expiration date, document matching may be ambiguous.
Insurance records missing an expiration date are excluded from the import.
12. FTCA (Federal Tort Claims Act) Coverage
FTCA Coverage Certificate Document
Conditions & Nuances:
FTCA coverage is only imported if the organization has the CAQH Bulk Import feature enabled.
At least one of the provider's active practice locations in CAQH must have the "Covered by FTCA" flag set to true.
If multiple FTCA documents exist, the most recently received document is used.
If the org and practice-location conditions are met but no FTCA document exists, a placeholder coverage record is created to indicate the coverage flag was found. Downstream credentialing logic determines how this is surfaced.
13. Hospital Affiliations
Three types of hospital affiliations are imported:
Admitting Privileges:
Institution Name, Status, Admitting Privilege Type, Primary Institution Flag, Specialty Limitations, Unrestricted/Temporary Privileges Flags, Admission Percentage, Admits per Month, Privilege Restriction Explanation, Application Date, Start Date, End Date, Exit Explanation, Department Phone, Associate Name & Contact Info, Time Spent at Facility, Admit Clients from Practice Locations, Ambulatory Surgery Center Flag, Military Hospital Flag, Phone, Fax, Email, Medical Staff Fax, Address (Street, City, County, State, Postal Code)
Admitting Arrangements:
Institution Name, Status, Admission Arranged By, Admitting Practitioner Details (Name, Specialty Match, Phone, Email, NPI), Admitting Organization Details (Name, NPI, Phone, Email), Arrangement Detail Description, Start Date, End Date, Phone
Non-Admitting Affiliations:
Institution Name, Status, Discontinuance Reason, Affiliation Description, Start Date, End Date, Phone
Conditions & Nuances:
Status values, admission arrangement types, admitting privilege types, and discontinuance reasons are mapped from CAQH's text labels to Medallion's standardized values.
14. Disclosure Questions & Answers
Question Text
Answer (Yes / No / Not Applicable)
Explanation/Reasoning Text
Conditions & Nuances:
Disclosure questions come from both CAQH-level and state-specific questions. State-specific questions are tagged with the relevant state.
Certain CAQH disclosure questions are excluded from import where they are not relevant to the credentialing process.
If a disclosure question has associated malpractice claim history details, the explanation text is pulled from those entries rather than the general answer detail field.
If a question has never been seen before in Medallion's system, it is automatically created and flagged for the operations team to review.
If duplicate answers exist for the same question with conflicting Yes/No values, the conflict is flagged for review.
15. Payer Enrollments
Medicaid: Provider ID Number, State
Medicare: Provider ID Number, State
Conditions & Nuances:
Payer names are formatted to include the state (e.g., "Medicaid - California").
If the state value from CAQH is not a valid US state, the enrollment is still imported but the issue is logged.
16. Gap Records (Employment Gaps)
Gap Start Date
Gap End Date
Gap Explanation(s)
17. Practice Locations
Medallion imports a subset of the practice location fields available in CAQH:
Active Locations:
Practice/Organization Name, Group TIN, Practice NPI(s), Start Date, Practice Type, Covered by FTCA Flag, Address (Street, City, State, Postal Code, Country), Last Edited Date
Archived/Inactive Locations:
Same fields as active locations, without the FTCA flag
18. Credentialing Contacts
Contacts are imported from up to three sources in CAQH:
Office Managers:
First Name, Last Name, Phone, Fax, Email
Practice Location Credentialing Contacts:
First Name, Last Name, Phone, Fax, Email, Primary Contact Flag
Provider (Self):
First Name, Last Name, Email
Conditions & Nuances:
Office managers are only included as credentialing contacts if designated as a credentialing contact in CAQH.
All credentialing contacts must have a valid email address. Contacts with a missing or invalid email are excluded.
19. CME Credits (Continuing Medical Education)
Course Title
Credit Hours
Date Completed
20. Attestations & Application Releases
CAQH Application Release Document
Conditions & Nuances:
Attestation records are only created for auto-triggered imports. Manual syncs pull the document but do not create an attestation record on the profile.
If the standard CAQH application release document is not available, state-specific release or state authorization documents are accepted as substitutes.
If no acceptable attestation document is found, no attestation record is created.
The CAQH Attestation Date is tracked on the provider profile.
21. Additional Names (Maiden Names, Former Names, etc.)
First Name
Last Name
Conditions & Nuances:
Additional names are only imported if the provider has other names listed in their CAQH profile.
If no additional names are present, the "Additional Names" section is marked as skippable.
Note: CAQH also provides date range and explanation for alias entries, but only the name fields are currently imported.
22. Documents & Files
Documents uploaded to the provider's CAQH profile are pulled in and linked to the appropriate records:
Application Release / State Release / State Authorization
Board Certification Documents (primary specialty only)
Malpractice Certificate of Insurance (COI)
FTCA Coverage Documents
Conditions & Nuances:
COI documents are matched to insurance records by expiration date.
Board certification documents are only linked to the primary specialty board cert record.
State release and state authorization documents can substitute for the standard application release.
Document download failures are treated more strictly during auto-triggered imports (the import is halted). During manual syncs, the error is logged and the import continues with the remaining data.
CAQH Fields Available But Not Imported by Medallion
CAQH's PDQS API exposes approximately 310 fields across all queries. The following are available from CAQH but either partially imported or not imported at all:
Category | CAQH Fields Available | Medallion Status |
Military Service | Branch, service dates, rank, discharge details, court martial info, last service location (13 fields) | Not imported |
Faculty Appointments | Institution name, specialty, dates, address | Not imported |
Other Training | Institution name, specialty, dates, address | Fetched but not applied to the profile |
Malpractice Insurance | Carrier phone/fax, agent names, policy holder, insurance type, excess coverage, unlimited coverage flag, tail/nose coverage, prior act coverage, and more (46 fields total) | Partial — 7 fields imported |
Practice Locations | Answering service info, county, location tax IDs, end dates at location, and more (62 fields total) | Partial — subset imported |
Additional Names | Date range and explanation for aliases | Partial — only first/last name imported |
ECFMG | Issue date, expiration date | Partial — only the ECFMG number is imported |
Disclosures | Disclosure date | Partial — date field not imported |
General Notes & Caveats
Data availability: The import can only pull in data that the provider has entered into their CAQH ProView profile. Incomplete CAQH profiles result in incomplete imports.
Data mapping: Certain values from CAQH are mapped to Medallion's standardized categories (profession types, license types, countries, races). Unrecognized values may default to a generic value such as "Other."
Section-level error handling: If a specific section of the CAQH data cannot be parsed, that section may be skipped while the rest of the import continues. Document download failures are treated more strictly for auto-triggered imports — they halt the entire import.
Deduplication: Malpractice insurance records are deduplicated to avoid multiple entries for the same policy.
Conditional sections: Some profile sections (Additional Names, Board Certifications) are marked as "skippable" if no relevant CAQH data exists, meaning they won't be flagged as incomplete during credentialing review.
No variation by user role: The CAQH data fields applied to the provider profile are the same regardless of whether the import is triggered by a provider, an admin, or Medallion staff.