The Advantages of Partnering with a Full-Service Credentials Verification Organization (CVO)

The Advantages of Partnering with a Full-Service Credentials Verification Organization (CVO)

Manually enrolling a single provider in a health plan can take anywhere from 3 months to 12 months.

Provider credentialing—establishing that providers are appropriately trained and competent to care for patients—is a time-consuming process that is highly regulated at the state, federal and payer levels. When it’s done manually, provider credentialing can take up to six months. Incomplete or inaccurate information regarding a physician’s work history, professional certifications, and malpractice insurance can lead to extensive delays and lost revenue. Credentials Verification Organizations (CVOs) perform provider credentialing on behalf of a healthcare organization, verifying providers’ documents for the organization.

CVOs that are NCQA Accredited in Credentialing go above and beyond verifying provider credentials to provide full-scope credentialing services. Following best-practice credentialing policies and procedures, these organizations handle all aspects of a full-service credentialing program.

Here’s a closer look at what a CVO that is NCQA Accredited in Credentialing handles on behalf of your health system. After the CVO receives a credentialing application, experts:

  • Check the application to be sure it’s complete and accurate. Credentialing experts reach out to providers to gather additional or missing information. Data security protocols ensure that provider data is protected.
  • Initiate Primary Source Verification (PSV) procedures to be sure credentialing documents are accurate. PSV requires that specific elements be verified directly by the original source that provided the credential. For example, a certifying board (not a certificate) is the primary source for board certification credentials.
  • Evaluate the findings of the PSV against the policy infrastructure of the organization that will include state, federal, and accrediting body standards.
  • Categorize credentialing files as “clean” versus “case.” Clean files meet a long list of criteria, including (but not limited to):
    • The application and attestation are complete, signed, and dated.
    • All the required documentation is present in the file.
    • All information requiring verification has been verified within the specified time limits.
    • The documentation and verifications sources reveal that the physician has:
      • An active medical license and current malpractice insurance
      • Education, training, and Board Certification as required
      • No malpractice claims history or state or Medicare/Medicaid sanctions
      • No history of loss of license, loss/limitation of privileges, or disciplinary action
  • Prepare a complete credentialing file—including credentialing checklists, original applications, and supporting documentation—for review and approval by your Credentialing Peer Review Committee (CPRC).
  • Prepare a full set of verifications on all credentials—stamped and dated in accordance with credentialing standards—to pass any audit.
  • Schedule and host your CPRC meeting and record the decisions. All you have to do is show up, review the credentialing files prepared by the CVO, and make your decisions.
  • Generate and send provider notification letters. When necessary, the CVO handles the Appeals Rights and Hearing Process.

After the credentialing process is complete, a CVO that is NCQA Accredited in Credentialing performs ongoing monitoring of provider performance (e.g., sanctions and complaints) and handles the re-credentialing process at the appropriate time. The CVO also keeps track of expiration dates for medical licenses, DEA registration, professional liability insurance, and other credentials, to be sure they are valid at all times.

TractManager is one of only two CVOs that is NCQA Accredited in Credentialing. TractManager’s comprehensive provider credentialing services reduce the standard credentialing process time from 180 to 30 days. We are a true one-stop shop—a long-term operational PARTNER you can TRUST and EXPERTISE you can count on.

To learn about our Delegated Credentialing solution, download the white paper titled “To Delegate or Not to Delegate.”

Author:

Anna Arutyunyan

Vice President, CVO, Provider Management

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

 

To Delegate or Not to Delegate – That is the Credentialing Question

Realize improvements in the processes that govern the growth and representation of your network, shorten turnaround times for network participation, enhance provider experience and brand integrity, and expedite access to revenue.

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