Using a Verifications Service

Credentialing assures that healthcare providers are qualified, competent, and licensed to provide safe, high-quality care. Before allowing practitioners to treat patients, hospitals and healthcare institutions must conduct a multi-step process to validate their qualifications.

Hospitals utilize primary source verification (PSV) as a credentialing requirement to protect patients and avoid negligent credentialing lawsuits.

PSV is essential in healthcare credentialing and enrollment since it verifies healthcare professionals’ or entities’ information from the source. Before giving rights or enrollment in healthcare networks, this verifies qualifications, licenses, certificates, education, training, and professional background.

PSV safeguards providers, healthcare organizations, and most crucially, patients. By verifying provider qualifications and standards, it reduces risks, ensures regulatory compliance, and preserves provider networks.

Inaccurate provider credentialing can endanger patient safety and lead to malpractice lawsuits.

PSV is essential in healthcare credentialing and enrollment since it verifies healthcare professionals’ or entities’ information from the source. Before giving rights or enrollment in healthcare networks, this verifies qualifications, licenses, certificates, education, training, and professional background.

If you don’t have access to a Primary Source, some secondary sources may be factored into your verification, such as:

  • Written declarations by successor organization leaders
  • Finding where original documents were sent after a hospital closure
  • Contacting nearby hospitals to see if anyone can provide primary source verification.

 

When using a secondary source, it’s important to verify provider information from original sources, use a designated equivalent, or find a knowledgeable secondary source to protect your credentialing process, patients, and legal risk.

Your healthcare business can streamline and protect primary source verification by outsourcing it to a Credentials Verification business (CVO), decreasing noncompliance, inaccuracy, and costly audits.


These and other equivalent sources are accepted by the Joint Commission for credentials verification:

  • The American Medical Association (AMA) Physician Masterfile verifies U.S. and Puerto Rican medical school graduation and postgraduate education completion using primary source provider data.
  • The American Board of Medical Specialties (ABMS) verifies physician board certification.
  • The Educational Commission for Foreign Medical Graduates (ECFMG) verifies foreign medical school graduates.
  • The American Osteopathic Association (AOA) Physician Database for pre-doctoral education recognized by the Bureau of Professional Education, post-doctoral education approved by the Council on Postdoctoral Training, and Osteopathic Specialty Board Certification.
  • Physician assistant education profile from the American Academy of Physician Assistants (AAPA) through the AMA Physician Profile Service.
  • The Federation of State Medical Boards (FSMB) Disciplinary Action Databank for all medical license disciplinary actions.

 

Some companies also assign verification requests to an agent. Credentialing specialists can swiftly check a provider’s information with confidence using a specified equivalent source, if available.

Credentialing organizations contact the original source to check applicant information.

Usually, you get written, phone, or online verification.

When calling a primary source to verify information, include the following details to document the call:

  • Organization name
  • Date contacted
  • One contacted
  • Person contacted phone number
  • Asking questions
  • Questions answered
  • Respondent’s name
  • Name and signature/initials of verification collector
  • Completed verification date

 

If you print a copy of a primary or equivalent source’s website to check credentials, record the following:

Name and birthdate of practitioner

  • Verifying the practitioner’s credentials and details
  • URL of webpage
  • Verified date
  • Initials of the verifying person
  • When should you use secondary sources?
  • Primary sources may not always be reliable.

 

If primary sources fail to verify qualifications, check education and licensure with the licensing board or an analogous source.

PSV safeguards providers, healthcare organizations, and most crucially, patients. By verifying provider qualifications and standards, it reduces risks, ensures regulatory compliance, and preserves provider networks.

Inaccurate provider credentialing can endanger patient safety and lead to malpractice lawsuits.

Licensure, certifications, education, training background, and professional affiliations originate from the granting organization. They may include:

  • State and federal agencies
    • Licensure
    • Sanctions
    • The National Practitioner Data Bank
    • Certifications by state
    • Certification for controlled substances
    • Background checks
    • A criminal history
    • Military personnel records

 

  • Educational institutions
    • Medical school and post-grad records

 

  • Hospitals/Employment
    • Career history
    • Granted privileges

 

  • Medical Professional Associations
    • Affiliations
    • Professional certificates

 

  • Individuals
    • If a provider provides a personally written peer reference or confirmation, you must contact that person to verify its accuracy and ensure that the peer knew enough about the provider to make a professional assessment or recommendation.

The Joint Commission, which accredits most U.S. hospitals and health systems, requires authorized healthcare institutions to verify credentials using primary sources, including:

 

  • Diplomas from medical school
  • A specialty or residency certificate
  • A license to practice
  • Registration with a medical or dental council or other certification needed by law, regulation, or hospital policy
  • Certification from recognized educational or professional bodies for clinical privileges

 

Unless needed by hospital policy, the Joint Commission does not seek primary source verification of professional history, letters of recommendation, criminal background checks, identification verification, immigration, and financial records.

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