Thoroughly Verifying Provider Licenses and Certifications Improves the Quality of Health Care

Maintaining and improving quality health care is the collective goal of health care organizations, providers, and state and federal entitlement programs.

An important factor to providing quality health care is assuring a provider’s competency by verifying that the type of care a physician is providing matches the license that physician holds, that the license is verified and in good standing, and that all data on licenses held, past and present, across all states, is looked at for a complete view of the provider.

TRACKING HUNDREDS OF STATE LICENSING BOARDS

With hundreds of medical and individual state boards, it is an insurmountable administrative burden to monitor and verify a provider’s past and present license(s) and board certifications. The health care industry ascribes to a code of conduct that suggests if information is attainable, it should be collected and used to assure full transparency on health care providers.

KEEPING THE PROMISE TO PATIENTS

Patients assume that their health care organization or clinic has done their due diligence in properly screening their providers—that the provider caring for them and their family has a current license to practice; as well as assurance of the quality of the provider’s character from a historical perspective. Obtaining a complete and accurate view of any provider requires far more than verifying the current license status, it requires a view of their license history and all statuses associated with that license(s) as well as checking all states where licensure has been held by the individual. State hopping is an issue that cannot be overlooked during the verification process.

For credentialing professionals to research the license history of a provider in order to rule out a pattern of losing or surrendering licenses for adverse behavior it requires ongoing contact with every licensing board in the United States on behalf of each provider. The same process applies to verifying the status of a license and connecting each license to the state of practice, current and historical, and the type of care the provider is offering. Much like finding a moving needle across hundreds of haystacks.

PROTECTING AN ORGANIZATION’S ABILITY TO DELIVER QUALITY CARE

Many organizations only verify that a provider’s license is active/not expired in the current state in which they are employed. It is vitally important to do more than this. Licenses can be impaired, revoked, suspended, restricted, on probation, or superseded. Identifying all the states a provider has practiced in, and all additional licenses and the status of those licenses, gives a complete view of the provider.

On an important and additional tier of transparency, a health care organization is well served by protecting itself from fines, civil monetary penalties, and legal risk. Seeking reimbursement from a state or federal entitlement program on services rendered by a provider with an expired license or the incorrect license type can result in millions of dollars of fines as well as exposure to lawsuits and possible negative news coverage in the event of harm caused to patients.

VERIFIED LICENSE SEARCH AND STATUS® DELIVERS REAL TIME LICENSE DATA

For this reason, Verisys Corporation launched its Verified License Search and Status® (VLSS) service, a real-time transaction engine that actively gathers, monitors, and verifies primary source data on health care providers from licensing boards in every state and U.S. jurisdiction. Using this search engine Verisys provides you with a full license history on a provider by searching all licenses the provider has held, past and present, across all taxonomies.

The VLSS data aggregation platform conforms the different formats of data as well as the different reference descriptors into one searchable data set. The Verisys VLSS team then engages its proprietary matching logic and sophisticated algorithms to match license records to identities with 99% accuracy nearly 100% of the time.

This streamlined, secure, accurate, and real-time delivery of critical data on providers reduces risk to patients and organizations and assures a fully transparent view into your entire provider population, current and historical.

Learn more about how Verisys can assist your HCOs in meeting all government and regulatory standards.

Written by Verisys Verisys transforms provider data, workforce data, and relationship management. Healthcare, life science, and background screening organizations rely on our comprehensive solutions to discover their true potential. Visit verisys.com to learn how we turn problems into power. Secure, configurable, and proven solutions Accurate, compliant, and complete information NCQA, URAC, and ISO accreditations/certifications Follow us on LinkedIn