Shannen, we have known each other for years and before we begin, there is no one I know in…
Overwhelmed with maintenance, credentialing, or compliance. Advanced Quality Compliance offers all the steps in provider credentialing.
Provider Credentialing or Primary Source Verification is the process of organizing and verifying a provider’s professional records. Their NPI, professional licenses, diplomas, certifications, attestations and professional references make up a provider’s professional credentialing file. This process is completed every 2-3 years depending upon an organization’s accreditation status. The process of credentialing is to verify the accuracy and specific data in a provider’s documents as required by different accrediting entities.
When a provider applies for privileges at a Hospital, Surgery Center, Insurance Companies and/or Physician Organization. They are required and requested to complete an application and allow the credentialing entity to research their educational and professional history. Our provider credentialing specialists will help you and your organization thru the entire process.
Organizations will verify with other third-party agencies, and possibly request a credit report or criminal background search. This process is called Primary Source Verification (PSV) which is the process of requesting and receiving verification of a provider’s stated credentials from the college or other entity that issued the diploma or certificate.
It is very important that your documents are accurate and they all match. Problems begin when there are inaccuracies and discrepancies between various records. Another problem area can occur when professional references do not respond in a timely manner, making sure that CVOs have all the needed items to verify helps the process run smoothly. AQC has many proven methods to close files within 30 days.
The major question is has the CVO undergone NCQA (National Committee on Quality Assurance) or URAC (Utilization Review Accreditation Commission) review processes? CVOs that are accredited or certified by these organizations demonstrate excellence in all areas of credentialing, primary source verification, data management, and data security. This is an important question to ask when evaluating which CVO is best for you.
NCQA Credentialing Accreditation is designed to ensure that organizations can maintain a high-quality network for members and contracted clients. Requirements cover these key areas: An internal QI process. Ensuring appropriate agreements and collaboration with clients. Ensuring data protection and auditing CVO’s processes and files.