The Vital Role of Primary Source Verification in Medical Credentialing

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Healthcare providers, ranging from hospitals to clinics, recognize the paramount importance of thorough credentialing when onboarding or renewing a provider’s contract on their team. Primary Source Verification (PSV) plays a vital role within the credentialing process as it mitigates risks, upholds regulatory compliance, and, most importantly, safeguards the well-being of patients.  

In this article, we’ll explore the importance of PSV and how healthcare organizations can ensure compliance through accuracy. 

Table of Contents

What is Primary Source Verification (PSV)?

Primary Source Verification is a mandatory procedure for healthcare providers wishing to provide patient care. It is guided by stringent laws and regulations, acts as a pivotal safeguard, ensuring that those responsible for patient care hold genuine and current licenses, certifications, or registrations.  

In essence, PSV involves confirming an individual’s state or federally-mandated license, certification, or registration with the respective licensing authority or its designated representative. The Joint Commission, a prominent accrediting entity for healthcare organizations and programs across the United States, mandates the performance of primary source verification, both during initial hiring and at the time of renewal.

Additionally, it stipulates that the practitioner must maintain a valid and unblemished license throughout their tenure and when delivering patient care. 

While the concept of PSV remains consistent, healthcare organizations encounter various providers specializing in this meticulous verification process. Here, we highlight some prominent Primary Source Verification providers that play a crucial role in upholding the integrity of healthcare credentialing: 

  • Educational Institutions  

Universities, colleges, high schools, etc. Every educational institution or accreditation that the applicant claims to have should be verified.  

  • Past Employers 

Hospitals, clinics, private practices, etc. The applicant must provide a chronologically correct list of past employers, which must be verified.  

  • Background/Criminal History Checks 

Background check services may access county, state, and federal databases, including databases maintained by law enforcement agencies. 

  • Professional Associations  

These include affiliations and professional certifications that must be cross-referenced and fact-checked. 

  • Peer References 

Peer references and professional connections also need to be verified to detect any inconsistencies in the information that was provided.

Designated Equivalent Sources (DES)

The Joint Commission defines a Designated Equivalent Source (DES) as “selected agencies that have been determined to maintain a specific item(s) of credential(s) information that is identical to the information at the primary source.” 

So, in short, a DES is a source that is not the primary source but are still accepted by the Joint Commission. Here are some examples of DES’s.  

  • American Medical Association (AMA) 

As a trusted provider, AMA specializes in verifying the primary credentials of medical professionals and ensures the authenticity and currency of medical licenses, certifications, and registrations. 

  • National Student Clearinghouse 

Primarily focused on educational credentials, the National Student Clearinghouse verifies academic qualifications. It ensures that healthcare professionals possess the educational background required for their roles. 

  • American Board of Medical Specialties (ABMS) 

ABMS takes the lead in verifying the specialized credentials of physicians across various medical disciplines. It ensures the accuracy of specialty certifications, contributing to the overall assessment of a physician’s qualifications. 

  • National Council of State Boards of Nursing (NCSBN) 

NCSBN specializes in verifying the primary credentials of nursing professionals. It confirms the authenticity and currency of nursing licenses, enhancing the credibility of nursing staff.

What Needs to be Verified?

The spectrum of PSV extends beyond the conventional checkmark of licenses. It encompasses the meticulous verification of specialty training or residency certificates. This depth of scrutiny ensures that healthcare professionals not only hold valid licenses but also possess the specialized education and training required for their designated roles.  

Here are some of the key elements that must be verified: 

  1. License Verification:

Confirm the validity and status of the healthcare professional’s state or federally-required license with the licensing authority.

      2. Specialty Training or Residency Certificates 

Verify any specialty training or residency certificates to ensure the healthcare professional has acquired specialized education relevant to their designated role. 

      3. Board Certification 

If applicable, verify the healthcare professional’s board certification status, ensuring they meet the specific standards and requirements of their specialty.

      4. Educational Credentials 

Confirm the healthcare professional’s educational background, including degrees and certifications, to validate that they have completed the necessary educational requirements for their field. 

      5. Work History and Experience 

Verify the healthcare professional’s work history and experience to ensure alignment with the information provided and to assess their suitability for the intended role. 

      6. Clinical Privileges: 

Check the healthcare professional’s clinical privileges at various healthcare facilities to ensure they are authorized to perform specific procedures or services. 

      7. Malpractice History 

Review any history of malpractice claims or disciplinary actions to assess the healthcare professional’s track record in delivering safe and effective care. 

      8. Continuing Education 

Ensure that the healthcare professional has participated in required continuing education programs to stay current with advancements in their field. 

      9. Insurance Coverage 

Verify that the healthcare professional maintains appropriate professional liability insurance coverage. 

      10. Drug Enforcement Administration (DEA) Registration 

Confirm the healthcare professional’s DEA registration, if applicable, allowing them to prescribe controlled substances. 

      11. National Provider Identifier (NPI) Number 

Verify the healthcare professional’s NPI number, ensuring accurate identification and enrollment in the National Provider System. 

      12. Immunization Records 

Validate the healthcare professional’s immunization records to ensure compliance with healthcare facility policies and safeguard against infectious diseases. 

      13. Peer References 

Contact peers or colleagues for professional references to gain insights into the healthcare professional’s collaborative skills and interpersonal relationships. 

      14. Background Check 

Conduct a comprehensive background check, including criminal history and other relevant checks, to ensure the healthcare professional meets safety and regulatory standards. 

      15. Professional Affiliations 

Verify memberships in professional organizations to assess the healthcare professional’s commitment to ongoing professional development and standards. 

What is a CVO?

In the orchestration of Primary Source Verification, Credentialing Verification Organizations (CVOs) play a pivotal role. These specialized entities are entrusted with managing the intricate details of PSV, leveraging technology, expertise, and direct connections with primary sources.  

By doing so, CVOs elevate the efficiency of the verification process, ensuring healthcare organizations stay compliant and maintain the highest standards in credentialing.

What Are the Advantages of Outsourcing to a CVO?

Outsourcing PSV to a Credentialing Verification Organization (CVO) unfolds a myriad of advantages for healthcare organizations. Beyond meeting the stringent standards set by the Joint Commission, CVOs bring a level of precision and reliability to the verification process that is often challenging to achieve in-house.

medical credentialing process

1. Expertise and Specialization 

CVOs specialize in credentialing and verification processes, bringing a wealth of expertise to ensure accurate and thorough verification of healthcare professionals’ credentials. Their dedicated focus on this specific function enhances the precision of the verification process. 

2. Regulatory Compliance 

CVOs stay abreast of the constantly evolving healthcare regulations and accreditation standards. Outsourcing to a CVO helps healthcare organizations ensure continuous compliance with industry regulations, reducing the risk of non-compliance penalties and enhancing overall regulatory adherence. 

3. Time and Resource Efficiency 

Outsourcing PSV to a CVO streamlines the credentialing process, saving valuable time and resources for healthcare organizations. CVOs leverage efficient workflows and technology to expedite the verification process. Their relationships with insurance companies as well as their in-depth knowledge of their processes, help expedite the credentialing process.  

4. Mitigation of Credentialing Backlogs 

CVOs can effectively handle surges in credentialing demands, preventing backlogs that can occur when managing the process in-house. This ensures timely onboarding of qualified healthcare professionals, reducing delays in providing patient care. 

5. Enhanced Accuracy and Reliability 

The specialized nature of CVOs ensures a meticulous and accurate verification process. By outsourcing PSV, healthcare organizations benefit from a higher level of reliability in credential verification, reducing the risk of errors and enhancing the overall quality of the credentialing process. 

Outsourcing to a CVO, like Neolytix aligns with the strategic goals of healthcare organizations, offering a tailored solution that optimizes efficiency, accuracy, and compliance in the credentialing and verification of healthcare professionals. 

Neolytix has been helping healthcare organizations nationwide for over 12 years and has become renowned for providing expedited credentialing and medical licensing services. Schedule a free demo today to see how we can alleviate the credentialing burden so your providers can become billable faster.

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