CAQH Malpractice Section: Occurrence or Claims-Made?

Last reviewed: October 7, 2026.

Your certificate of insurance or policy declarations page says whether your malpractice policy is occurrence or claims-made. Read it there, or ask the carrier, rather than guessing. Then enter the per-claim and aggregate limits from the same document, because missing limits are what most often hold up the CAQH insurance section.

What the two answers mean

HPSO, a common carrier program for therapists, describes occurrence coverage as covering incidents that take place during the policy period, even if the claim is reported later. Claims-made coverage responds to claims made and reported while the policy is in force, or during an extended reporting period. A claims-made policy also has a retroactive date, and tail coverage extends the time to report a claim after a claims-made policy ends. HPSO notes that neither form is automatically better.

CAQH is only asking which one you have. The payer requests we handle are about current dates and minimum dollar limits, not about which form you chose, so answer what the policy actually says.

Why the CAQH insurance section stalls

In our experience the policy form is the easy part. These are the issues that actually delay attestation:

• A payment confirmation instead of a certificate. Renewal receipts and payment emails usually show the premium, not the limits. CAQH needs the per-occurrence or per-claim limit and the aggregate limit, and those are on the certificate.

• A link instead of a file. Carrier emails often link to a document that only opens under the policyholder’s own login. Whoever maintains your CAQH profile cannot open it. Download the certificate and send it as a PDF.

• An expired policy period. If the policy renewed, the profile still shows last year’s dates until someone uploads the new certificate.

• The wrong insured. Payers ask for a certificate showing the named insured. Check that it matches the clinician whose profile you are completing.

Where to find the answer on your documents

1. Open the current certificate of insurance or the declarations page, not the renewal receipt.

2. Look for the wording that names the coverage form, occurrence or claims-made, on the professional liability coverage.

3. Copy the policy number, effective and expiration dates, and both limits. A figure labeled “each claim” or “per occurrence” is a dollar limit; use the form wording, not that label, to answer the policy-type question.

4. If it is a claims-made policy, note the retroactive date if the form asks for it.

5. If none of that is clear, ask the carrier or broker in writing which form the policy is.

HPSO’s sample certificate also lists the program administrator separately from the insurance company that underwrites the policy. When CAQH asks for the carrier, use the insurer named on your certificate.

Limits payers ask for

Minimums vary by payer, so check each one. For example, one Blue plan we enroll with asks for at least $1 million per claim and $3 million aggregate, and Medi-Cal’s therapist checklists list $100,000 per claim and $300,000 aggregate. Keep the certificate current in CAQH so each payer reads the same values.

New to CAQH? Start with how to create and complete a CAQH account. Bomi maintains and re-attests CAQH profiles for the clinicians it credentials, so we ask for the certificate PDF whenever a policy renews.

Frequently Asked Questions

Is a claims-made policy a problem for credentialing?

Not by itself. Payers look at whether coverage is current and meets their minimum limits. Answer the policy-form question accurately.

Why does CAQH keep asking for my malpractice limits?

Usually because the document on file is a receipt or a link, not the certificate. Upload the certificate or declarations page that shows the per-claim and aggregate limits.

Sources

• HPSO coverage FAQ

• HPSO sample certificate of insurance

• DHCS LCSW application information (Medi-Cal liability minimums)