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CVO credentialing refers to the use of a Credentials Verification Organization to perform medical credentialing on behalf of a healthcare practice or organization. The 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 be reimbursed for services.

Credentialing healthcare providers can include verification of their license, education, medical training, work experience, and other qualifications that confirm their status. The CVO acquires documents from the primary source such as state licensing boards, educational institutions, and exclusion lists and does not accept self-reported data for these requirements. CVOs can acquire the provider’s current and historical records of exclusions, sanctions, debarments, and other disciplinary actions or abusive activity. Doing so safeguards your patients and organization 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, organization workflow is disrupted (e.g., file backlogs, unfilled clinical positions, lost revenue, etc.), and patient care is compromised putting patients at the highest risk.

The Step-by-Step Process to earn a CVO Certification

The proper CVO certification process is outlined by the NCQA and includes in-depth pre-application, application, and post-application processes. The following are the appropriate steps an organization should follow to earn its CVO certification and become a trusted source of information.

  1. Pre-Application
  • Overview discussion: A call should be scheduled with a program expert at least 12 months before survey start date to discuss eligibility, benefits, and process.
  • Purchase the standard and survey tool: This tool provides a better understanding of evaluation areas and requirements.
  • Perform a gap analysis: Compare standards to your organization’s current processes and understand where the gap may be that needs to be filled
  • Submit the pre-application form: pre-application forms can be acquired from your program expert.
  1. Submit the online application: Once all criteria are filled you can apply and schedule the appropriate survey date
  1. Post-Application
  • Align with NCQA requirements: Approximately 9 months before the survey start date your organization should begin to align with program standards. All program standards should be aligned 6 months before survey date.
  • Submit the survey tool: Approximately 3 months before the survey start date an Accreditation Services Coordinator will contact your organization to review the process.
  • Earn CVO certification: Your certification status will be determined within 30 to 90 days of survey submission.

How Long Does the CVO Certification Process Take? 

The typical evaluation time frame from application submission to decisions is 12 months. However, this timeline can last much longer with poorly trained or inexperienced staff. The pre-application process can exponentially increase the timeline preparing documentation and reliable data. This could increase the timeline for certification up to three years.

Manual processes or errors could cause delays resulting in unacceptable timelines for onboarding and payments which may lead to difficulty retaining qualified, credentialed staff. A qualified and efficient CVO solves these challenges by optimizing a healthcare organization’s credentialing process. A trusted CVO will be able to efficiently navigate resources and standards, lend expertise, and provide technology augmentations to decrease administrative burden.

Choosing an Accredited CVO for Your Provider Credentialing

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 the best technology to constantly monitor thousands of primary source databases alerting your organization of any changes in provider status. With cross-checks across databases, 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 99.5% 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 institution is better equipped to provide premium quality care.

Juliette Willard Written by Juliette Willard
Healthcare Communications Specialist
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