The Importance of NCQA Certification for CVOs Verifying credentials for practitioners and affiliated organizations is a key component of patient safety in healthcare. To perform thorough, efficient,...
State & Federal Government
State Medicaid & Federal Government
Verisys aligns medical provider credentialing and directory services to reduce cost and administrative burden, while increasing provider and member satisfaction. Our solutions streamline and consolidate siloed departments to deliver tangible results.
As a government entity, you’re held to high standards. Verisys helps you meet them as a Credentials Verification Organization with certifications and accreditations from the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), International Organization for Standardization (ISO), and American Institute of Certified Public Accountants, Service Organization Trust Criteria (AICPA SOC2).
Verisys delivers streamlined flexible solutions for 10+ State Medicaid and Federal Departments. Here’s why:
- Automate credentialing and onboarding of providers and entity populations with both fee-for-service and managed care entities.
- Automate provider and entity supplier screening.
- Proactively prevent and mitigate fraud, waste, and abuse through risk-based alerts.
- Meet federal and state requirements in developing and maintaining a provider and entity population management system.
- Support the National Fraud Prevention Program (NFPP); 2 42 CFR Part 438, Subpart H; 42 CFR Part 455, Subparts B & E.
- Comply with CMS ACA3 medical provider screening and management requirements.
- Integrate to a State Enterprise Architecture.
- Comply with Medicaid Information Technology Architecture (MITA) 3.0 standards.
State Credentialing Alliance
Verisys leads the industry in managing state Medicaid credentialing programs in partnership with several state and state-wide consortiums. These alliances improve provider satisfaction while lowering credentialing costs by aligning credentialing to a single, common event, shared by participating managed care organizations.
Provider Data & Roster Management
Verisys’ provider directory management solutions transform often-flawed provider data into comprehensive, customizable directories that integrate seamlessly with your member portal. We display intricate networks how you want your members to see them, highlighting and tiering network providers just for them — including telemedicine providers.
By offering a more comprehensive, integrated provider search platform, you can keep current members satisfied and engaged while attracting new customers who want to strengthen member engagement. Moreover, by delivering relevant, actionable information, consumers can make informed decisions leading to better outcomes—one of healthcare reform’s primary goals.