The Vital Role of Primary Source Verification in Medical Credentialing

primary source

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. 

What is Primary Source Verification (PSV)?

Primary Source Verification (PSV) is a crucial procedure for healthcare providers seeking to deliver patient care. It’s a mandatory process governed by strict laws and regulations to ensure that individuals responsible for patient well-being possess valid and up-to-date licenses, certifications, or registrations.

Key Points About PSV

  • PSV involves confirming an individual’s state or federally-mandated credentials with the relevant licensing board or designated representative.
  • The Joint Commission mandates PSV during initial hiring and renewal to uphold healthcare standards.
  • Practitioners must maintain a valid and untarnished license while providing patient care.

Prominent PSV Providers:

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: 

  1. Educational Institutions: Universities, colleges, high schools, etc. Every educational institution or accreditation the applicant claims to have should be verified.  
  2. Past Employers: Hospitals, clinics, private practices, etc. The applicant must provide a chronologically correct list of past employers, which must be verified.  
  3. Background/Criminal History Checks: Background check services may access county, state, and federal databases, including databases maintained by law enforcement agencies. 
  4. Professional Associations: These include affiliations and professional certifications that must be cross-referenced and fact-checked. 
  5. Peer References: Peer references and professional connections must also be verified to detect inconsistencies in the provided information.

What are 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 to verify 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 hold valid licenses and possess the specialized education and training required for their designated roles.  

Here are some of the critical 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) has many advantages for healthcare organizations. Beyond meeting the stringent standards set by the Joint Commission, CVOs bring precision and reliability to the verification process, that is often challenging to achieve in-house.

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 experienced professionals like Neolytix perfectly aligns with the healthcare organization’s strategic objectives. Our tailored solutions optimize efficiency, accuracy, and compliance in credentialing and verifying healthcare professionals.

With over 12 years of experience, Neolytix has earned a reputation for delivering expedited credentialing and medical licensing services nationwide. Schedule a free demo today to witness how we can alleviate the burden of credentialing, enabling your providers to become billable faster.

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