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The Importance of NCQA Certification for CVOs

February 11, 2020

Verifying credentials for practitioners and affiliated organizations is a key component of patient safety in health care. A CVO (credential verification organization) with the proper procedures, processes, and data in place to do a thorough, efficient, and accurate credentialing of a provider population doesn’t happen by accident. It takes months and years of careful review, project planning, and process implementation to achieve the high standards expected by major payers and organizations such as the Joint Commission and CMS.

Organizations looking to achieve NCQA certification are committed to playing a vital role in both patient safety and quality care. This certification also gives industry recognition, trust and consistency, and oversight for clients needing practitioner verification. Importantly, it creates a pathway for a more streamlined, reliable credentialing process. It allows organizations to stay compliant with state and federal requirements and helps keep their accreditation with Medicare, Medicaid, TriCare, and other programs.

Since NCQA certification has become so important to identifying industry standards and quality, here’s what you need to know about NCQA certification.

What Is NCQA Certification?

The NCQA began accrediting health plans in the 1990s. Today, they’re one of the industry leaders in health care transparency, accountability, and measurement. They have highly respected accreditation and certification programs. They provide frameworks for health plans, providers, and other health care organizations to apply best practices and accurately and effectively screen and credential practitioners.

NCQA CVO Certification assesses an organization’s performance in internal quality improvement processes, security of credentialing information, efficient and accurate verification of credentials.

NCQA certification is a lengthy and involved process. For many organizations, certification can take upwards of 12 months, depending on how many of the standards are already being implemented. However, it can take up to three years or longer to have everything in place for certification. During this time, organizations are required to do the following:

  • Perform a gap analysis. About 9–11 months before a formal review, organizations should evaluate their current processes against the standards set by the NCQA. This analysis should bring to light any shortfalls or areas of improvement that can be resolved before the on-site survey.
  • Align with NCQA standards. Since many of the standards require a 6-month lookback period, starting early and creating a project plan is important to stay on track. Showing a consistent, air-tight verification process is key to certification.
  • Complete the survey process. The NCQA Certification Survey includes rigorous on-site and off-site evaluations conducted by a survey team that includes at least one CR surveyor and one administrative surveyor. Then, A Review Oversight Committee (ROC) of physicians analyzes the team’s findings and assigns a certification status based on the CVO’s performance against core standards and requirements.
  • Maintain compliance and certification. Preparation for re-accreditation should begin the moment an auditor leaves. That is to say, compliance doesn’t end with accreditation. Keeping up on and improving standards is just as important as the initial compliance and certification push.

Verisys Is One of Only a Few NCQA Certified CVOs

Credentialing with an NCQA-certified CVO ensures that only qualified and competent providers within your health care organization see and treat patients in your provider networks. Partnering with an NCQA-certified CVO shows your patients and members that you prioritize patient safety and compliance above all else.

Partnering with a CVO that has achieved this certification will also ensure that your organization is meeting the rigorous compliance standards set forth by NCQA, giving you the peace of mind that your organization is NCQA compliant by a reliable partner.

Verisys is one of only a handful of organizations that are NCQA certified in 11 of 11 credentials verification services. Verisys has been NCQA and URAC accredited since 2008 and is one of only a few CVOs that is accredited and certified by both organizations.

Verisys is certified in the following areas:

  • Medical Board Sanctions
  • Medicare/Medicaid Sanctions
  • Ongoing Monitoring of Sanctions
  • License to Practice
  • DEA Certification
  • Application Processing
  • Education and Training
  • Malpractice Claims History
  • Work History
  • CVO Application and Attestation Content
  • Board Certification Status

NCQA certification is voluntary. However, the rigorous standards encompass many industry best practices and going through the accreditation process shows a commitment to accuracy, transparency, and patient safety.

Verisys is proud to be an NCQA certified organization. For consumers and employers, the seal is a reliable indicator that an organization is well managed and delivers high-quality care and service.

Heather Lynn GillmanWritten by Heather Lynn Gillman
Director of Healthcare Communications
Problem Solver. Designer. Wine Maker. Writer.
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