Choose an Organization with NCQA Credentialing Accreditation – Not Just CVO Certification

The National Committee for Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of healthcare organizations, including those that handle provider credentialing. Provider credential verification is crucial for patient safety. Healthcare organizations must establish the qualifications of healthcare providers by assessing their background and competency to provide care.

Organizations can receive CVO Certification or Credentialing Accreditation. NCQA Credentials Verification Organization (CVO) Certification helps improve verification operations and protect consumers by ensuring a consistent, effective and diligent verification process. NCQA Credentialing Accreditation is designed to ensure that organizations can maintain a high-quality provider network for members and contracted clients.

How do these designations differ?

In a nutshell, Credentialing Accreditation is more comprehensive than CVO Certification.

CVO Certification evaluates the operations of organizations that verify practitioner credentials through the primary source, a recognized source, or a contracted agent of the primary source. Credentialing Accreditation evaluates the operations of organizations that provide full-scope credentialing services. In addition to verifying practitioner credentials, these organizations provide a designated credentialing committee that reviews practitioner credentials and makes credentialing recommendations, and they monitor practitioner sanctions and complaints between recredentialing cycles.

To receive NCQA CVO Certification, organizations must meet NCQA standards in three areas, demonstrating that they 1) have an internal quality improvement process; 2) protect provider credentialing information (i.e., data security); and 3) verify provider credentials consistently and effectively. Organizations that receive NCQA Credentialing Accreditation must meet the standards in those same three areas, as well as seven additional areas, demonstrating that they maintain appropriate agreements and collaboration with clients; have documented credentialing policies (to ensure integrity);provide a peer-review process (i.e., credentialing committee); re-evaluate providers in a timely manner(recredentialing); monitor providers’ performance (complaints, adverse events, and Medicare/Medicaid sanctions); notify authorities of safety/quality issues and notify practitioners of their appeal rights; andevaluate organizational providers, including behavioral health providers.

Both CVO Certification and Credentialing Accreditation mean that organizations apply industry best practices to deliver efficient and accurate credential verification services. Organizations with NCQACredentialing Accreditation go above and beyond credentials verification to handle the entire credentialing and re-credentialing process and monitor provider performance between credentialing cycles.

TractManager is the nation’s first Credentialing Verification Organization (CVO) with an integrated Contract Life Cycle Management solution to achieve NCQA Credentialing Accreditation.

 

Author:

Anna Arutyunyan

Vice President, CVO, Provider Management

Anna has extensive experience in the development and implementation of full-scope credentialing programs.

 

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