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, and accurate credentialing, a credentials verification organization (CVO) must have proper procedures, processes, and provider and workforce data in place.

Federal healthcare organizations such as The Joint Commission (TJC) and Centers for Medicare and Medicaid Services (CMS) allow CVOs to verify credentials on behalf of healthcare organizations, but before CVOs can perform these services, they must follow a process that takes months and years of careful review, project planning, and process implementation to achieve the high standards expected by major payers and healthcare organizations.

Why Does NCQA Certification Matter?

Organizations committed to taking a leading role in patient safety and quality care benefit from NCQA certification through industry recognition, trust and consistency, and oversight for clients needing practitioner verification. Not only does NCQA certification demonstrate the reputability of an organization’s provider credentials process, it also creates a pathway for a more streamlined, reliable credentialing process.  It allows organizations to stay compliant with state and federal requirements and maintains their accreditation with Medicare, Medicaid, TRICARE, and other programs.

NCQA certification has become essential to identifying industry standards and quality. It is understood throughout the industry that NCQA CVO Certification means an organization demonstrates high performance in internal quality improvement processes, security of credentialing information, and the efficient and accurate verification of credentials. Although applying for certification can be a lengthy and complex process, CVOs who are NCQA certified generate a high return on their investment because of the confidence the certification inspires in organizations who are considering hiring a CVO to assist them with their provider credentialing.

What Organizations are Eligible for CVO Certification?

Organizations that provide credentials verification services are eligible for CVO certification from NCQA, but the organization must first meet several benchmarks before being considered. Organizations seeking NCQA certification must meet all of the following qualifications:

  1. The organization must verify practitioner credentials for managed behavioral healthcare organizations (MBHO), physician organizations, healthcare organizations, or health plans;
  2. The organization must provide credentials verification services for at least six months prior to the CVO certification application;
  3. The organization must provide credentials verification services for at least 50% of practitioners under contract;
  4. The organization must keep records of and submit all NCQA-required documentation for credentials verification, policies, and procedures;
  5. The organization must carry errors and omissions insurance for $1M–$2M.

Steps to Navigating the NCQA Certification Process

  • 12 months before your survey: Plan your call to consult with a program expert, who will identify program benefits, explain eligibility criteria, and review the application process and areas of evaluation.
  • 12 months before your survey: Purchase the Standards and Guidelines and the Survey Tool from NCQA. These tools contain the complete standards, help determine your readiness for the survey, and give you a hypothetical survey score.
  • 9–11 months before your survey: Compare NCQA standards to your organization’s current processes and perform a gap analysis to help you create a plan for making improvements as needed.
  • 9-10 months before your survey: Request a pre-application form from a program expert. You’ll receive an online application link soon after the form is submitted.
  • 9 months before your survey: Submit the online application and select the desired survey start date. An NCQA representative will contact you to finalize the application and the survey date.

What to Expect After Your Submitting your NCQA Application

  • 9 months before your survey: Start working to align your organization with NCQA’s program standards. NCQA surveys require six months of data, so by the time you’re six months away from your survey’s start date, you should be fully compliant with NCQA standards.
  • 3 months before the survey start date: an Accreditation Services Coordinator from NCQA will contact your organization. The coordinator will explain the survey process and answer your questions.
  • On the assigned survey start date: Complete and submit the Survey Tool you received from NCQA to start the survey process. Depending on your CVO Certification program, an onsite file review may also be required seven weeks after your survey is submitted.
  • 90 days after survey submission (or within 30 days of your onsite file review): NCQA will determine your certification status. NCQA will send you a preliminary report, which you will review and return with any additional documentation needed within two weeks. The Review Oversight Committee then determines your final score.

Verisys Meets All 11 NCQA Credentials for CVOs

Credentialing with an NCQA-certified CVO ensures that only qualified and competent providers care for patients in your provider networks. As a CVO that has achieved this certification, Verisys can give partner organizations peace of mind that it is meeting the rigorous compliance standards set forth by NCQA.

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.

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

As an NCQA certified organization, Verisys meets rigorous standards pertaining to the healthcare industry’s best practices. Verisys’ NCQA certification is continuously maintained and renewed on time because of their commitment to data accuracy, provider transparency, and patient safety.

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

Learn more about how Verisys can streamline your credentialing processes.

Verisys Written by Verisys
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