What Is CVO Credentialing?

CVO credentialing refers to the use of a Credentials Verification Organization to perform medical credentialing on behalf of a healthcare practice or organization. A CVO verifies a provider’s credentials by obtaining primary source verification of a provider’s qualifications on the organization’s behalf. Upon verification, a provider may then enroll in payers’ health plans so that the healthcare organization can bill for services.

Credentialing healthcare providers can include verification of their license, education, medical training, work experience, malpractice insurance, and other qualifications for practice. A CVO acquires documents from primary sources such as state licensing boards, educational institutions, and exclusion lists and does not accept self-reported data for these requirements. CVOs can screen the provider for current and historical exclusions, sanctions, debarments, and other disciplinary actions. Doing so safeguards patients and healthcare organizations from dangerous practitioners.

Proper provider credentials verification can be a time-consuming process; primary sources must be checked, accurate identity matching must be confirmed, and providers should be monitored on an ongoing basis to alert organizations of any changes in status. Using a trusted, experienced CVO is beneficial for organizations that may not have the resources or staff to maintain this level of screening and monitoring. If not properly credentialed, insurance companies can deny coverage and organizational workflow is disrupted (e.g., file backlogs, unfilled clinical positions, lost revenue, etc.).

Should You Outsource Your Credentialing to a CVO?

Many healthcare organizations outsource their provider credentialing to a CVO to streamline the process, maintain compliance, and save both time and money. When hiring a CVO here are some things you should consider:

Experience

Does the CVO have experience in credentialing a variety of healthcare professionals? Does it have the technology to keep up with changing compliance regulations, shortened turnaround times, and accuracy requirements? The credentialing environment has never been more complex nor as demanding. Having an experienced, secure CVO in your corner will be critical to ensure credentialing for your organization is done properly. Improper credentialing may affect participation with Medicare and Medicaid and increase exposure to litigation. Qualifications and experience in a CVO team are essential to ensure safe, competent clinical providers, quality of patient care, and risk mitigation.

Accreditation

Has the CVO undergone NCQA (National Committee on Quality Assurance) or URAC (Utilization Review Accreditation Commission) review processes? CVOs that are accredited or certified by these organizations demonstrate excellence in all areas of credentialing, primary source verification, data management, and data security. To stay in good standing, CVOs must be re-evaluated every three years by NCQA and URAC review assessment teams who do both onsite and offsite assessments against the organizations’ performance standards. By holding a CVO to these high levels of scrutiny, your organization can ensure compliance standards are secure and up to date.

Custom Design

Every healthcare organization has different needs. When interviewing a CVO, make sure it has the capability to design a custom credentialing program that meets all your criteria. This will result in a scalable, configurable platform that is highly functional for your organization.

Verisys is an Accredited CVO for Provider Credentialing

Verisys provides services to thousands of healthcare organizations across the country, representing millions of healthcare providers, such as hospitals, pharmacies, skilled nursing facilities, assisted living facilities, home health programs, hospice, government entities, health plans, and pharmaceutical companies. We do so while ensuring the following consistencies:

• Accuracy. Detects omissions, multi-state licenses, actions, and status-change updates with 99.9% verification accuracy.
• Primary Sourced. Verisys has deep and long-term relationships with more than 5,000 primary sources.
• Breadth. Our full taxonomy includes all U.S. jurisdictions, nationwide for all license types, registrations, certifications, and more.
• Up to Date. Pulls data on primary source publishing schedules ensuring up-to-date and real-time information.
• Depth. Includes securely stored and aggregated longitudinal databases since 1992. This allows us to confirm the veracity of responses to, “Have you ever…?”
• Proven. Qualified and trained analysts and configurable solutions come with best practice accreditations and certifications.
• Quality. Uses several levels of certified quality assurance, ensuring best practice standards and processes are in place and documented during every step of engagement and process.
• Innovative. Pushing the boundaries to solve the biggest problems in provider data and network management is the standard operating procedure.
• Trusted Partners. As the largest outsourced CVO in the United States, we’ve served healthcare organizations for nearly three decades.

Choosing an accredited CVO is critical to provider data quality and security. Verisys is certified by NCQA and accredited by URAC, two leading accreditation organizations. Verisys’ real-time SaaS-based software utilizes technology to continuously monitor thousands of primary source databases alerting your organization of any changes in provider status. Verisys stands behind its data accuracy with full confidence.

Verisys’ technology works to expedite provider credentialing and simplify license status monitoring providing high-quality data with over 99.9% identity matching. Using our automated systems continuously working for your organization, staffing burden is reduced and organizational compliance is improved. By reducing liability and risk, minimizing financial and workflow constraints, and increasing patient confidence, your organization is better equipped to provide premium quality care. Contact Verisys to learn if delegating your credentials verifications is right for you.

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