When healthcare providers move between roles or organizations, their credentials must be checked thoroughly to verify they are who they claim to be and possess the qualifications to do the job. Credentialing helps ensure healthcare professionals have the proper training, education, and experience to provide safe, quality care. This process helps protect patients from potential harm if unqualified individuals can deliver medical services.
Primary source verification credentialing (PSV) is the gold standard of this process. It involves checking the accuracy of information found in a healthcare professional’s credentials by contacting the sources directly. For instance, if a provider’s resume states they completed a residency at XYZ University, PSV would include calling the school to verify that information rather than simply taking the provider’s word for it or checking a database. In this way, PSV helps reduce the likelihood of fraud, which is especially important in healthcare, as unqualified practitioners can pose serious risks to patients. Credentialing isn’t an easy task.
It’s time-consuming and often feels like an endless cycle of paperwork as professionals move on and new hires come in. Primary source verification can make the process longer, adding another layer of scrutiny that can catch even the most minor discrepancies. However, the benefits of PSV far outweigh the challenges. It ensures the safest care possible for patients and helps healthcare organizations reduce their legal and financial risks, avoid disruption in care, and maintain a solid reputation in the community.
This guide will discuss why primary source verification credentialing is critical in provider credentialing and how healthcare organizations can streamline this process for better outcomes. Azulity can help. Our provider credentialing services can lighten the load of your credentialing tasks and help you achieve your goals, like allowing your healthcare organization to use innovative data management.
What is Primary Source Verification Credentialing?
Primary Source Verification for credentialing confirms that an individual possesses a valid license, certification, or registration to practice a profession when required by law or regulation. In other words, it allows organizations to verify that a healthcare provider has the qualifications they claim to have before they are permitted to deliver care. The Joint Commission defines primary source verification as “verification of an individual practitioner’s reported qualifications by the source or an approved agent of that source.”
In simpler terms, primary source verification means going to the source to verify information rather than taking someone’s word for it or relying on a third party’s report. In the case of healthcare provider credentialing, the source would be the organization that issued the license or certification. For example, if a doctor claims to have a license to practice medicine in Florida, the primary source for verifying that information would be the Florida Department of Health. If the Florida Department of Health had an online database that allowed for secure electronic verification, that would be the preferred method of conducting primary source verification.
If such an option did not exist, the next best option would be to contact the Florida Department of Health directly to verify the doctor’s license. Simply relying on a copy of the doctor’s license as verification would not meet primary source verification requirements. While this example illustrates a common scenario in medical credentialing, primary source verification can be used in any industry where certifications and licenses are required to ensure qualified personnel perform their jobs. In addition to health care, primary source verification is commonly used in education, aviation, and various trades.
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Importance of Primary Source Verification Credentialing
Primary source verification credentialing is a detailed and thorough process that authenticates healthcare providers’ qualifications, training, and licensure. PSV involves contacting the organizations or institutions that issued a provider’s credentials to ensure they are accurate and up to date. For instance, if a nurse has a certification from an accrediting body, PSV would involve calling the organization to verify the nurse’s certification instead of taking the information at face value instead of taking the information at face value.
PSV is essential to mitigate risk and prevent bad hires within healthcare organizations. It is especially critical in the current environment where providers are under increased pressure due to workforce shortages and high turnover rates. As a result, some are resorting to falsifying credentials to obtain employment.
How Primary Source Verification Credentialing Improves Patient Safety
Patients trust healthcare providers during vulnerable moments. For instance, they are often not fully awake or alert when undergoing surgery. Instead, they rely on the surgical team to deliver quality care. When the team includes qualified individuals, patients can rest assured that they will receive proper care. On the other hand, if a lousy hire infiltrates the surgical team due to fraudulent credentials, there’s no telling what could happen. This is why primary source verification credentialing is at the heart of screening qualified providers.
How Does Primary Source Verification Credentialing Work
The Importance of Primary Source Verification Credentialing
Primary source verification credentialing is essential for verifying healthcare practitioners’ credentials. It’s a time-consuming process, but it is well worth the effort to safeguard patient safety. PSV involves authenticating a practitioner’s qualifications by directly contacting the organizations that issued their credentials.
For example, if a surgeon received a medical license from the state of California, primary source verification would involve contacting the Medical Board of California to confirm that the license is valid and has not expired or been subject to disciplinary action. This process helps ensure that the surgeon has the proper training and qualifications to perform surgery and that their credentials are accurate and from an unaccredited source.
A Closer Look At Primary Source Verification Credentialing
When verifying a new hire’s credentials, the approach can vary based on the resources and time available for primary source verification credentialing. Below are examples of how to effectively authenticate credentials:
Direct Contact
A widely adopted approach for completing PSV involves direct communication with the institution or organization responsible for issuing the credentials. This typically occurs through phone calls, emails, or online interfaces.
Digital Verification
Another avenue is digital verification platforms, which grant access to verified provider information and credentials from multiple sources. These platforms often employ artificial intelligence and machine learning algorithms to ensure information accuracy.
Third-Party Verification Services
These services have access to primary source data and can efficiently expedite the verification process.
In-House Verification
Many healthcare institutions opt to perform PSV in-house, utilizing their internal resources alongside credentialing software or platforms to manage the process internally.
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7 Tips for Effective Primary Source Verification Credentialing
1. Leverage Azulity for Credentialing Tasks
Azulity helps healthcare organizations gain control over their provider data and streamline credentialing processes. Azulity specializes in healthcare master data management and provider credentialing services, bringing proven expertise in implementing healthcare data solutions and credentialing across the US. Their comprehensive platform ensures consistent patient, provider, location, and claims data synchronization across all systems and departments.
Key features include healthcare master data management, provider master data management, reference data management, credentialing, and provider enrollment. They serve healthcare technology leaders—from CIOs and CDOs to VPs of data platforms and credentialing—helping them eliminate the costly problems of fragmented data systems. Book a call to learn more about their healthcare master data management services today!
2. Identify Information Requiring Primary Source Verification
Start the primary source verification process by identifying the information that needs to be verified by a primary source. According to an article from Joint Commission International, healthcare organizations should perform primary source verification for medical school diplomas, specialty training or residency certificates, licenses to practice, registration with a medical or dental council, or any other credential required by law, regulation, or hospital policy, as well as a certificate issued by recognized education or professional entities as the basis for clinical privileges.
Payers and other major accreditation organizations, such as CMS, National Committee for Quality Assurance (NCQA), and Det Norske Veritas Healthcare, Inc. (DNV), have similar requirements for primary source verification—although their requirements can differ. For example, the National Association of Medical Staff Services (NAMSS) reports that the Joint Commission, which certifies over 22,000 healthcare organizations and programs in the US, set a primary source verification standard for malpractice and adverse action checks through the NPDB. CMS, however, does not have any stated requirement to verify with the data source.
Determining what information must be traced to the primary source depends on the organization accrediting the hospital or practice and the facility’s bylaws, policies, and procedures. But industry experts offer best practices to navigate the standards set by accreditation organizations and payers. The Joint Commission, for instance, requires healthcare organizations to conduct primary source verification for medical school diplomas, specialty training or residency certificates, licenses, and any credentials issued by a recognized education or professional entity. However, it doesn’t require primary source verification of other items such as professional history, recommendation letters, criminal background checks, IDs, or immigration and financial documents unless these are required by hospital policy.
These verifications should be highly considered by the hospital, though, because they are best practices and can prevent a potentially harmful situation resulting from the appointment of a practitioner who provided fraudulent credentials,” the accreditation organization stresses. NAMSS also recommends that healthcare organizations perform primary source verification if just one accrediting organization requires it or if there are no stated requirements. For example, the association cites that neither CMS nor the Joint Commission has stated requirements for verifying board certification. In that case, NAMSS suggests performing primary source verification as a best practice.
3. Gather All Necessary Information
Proper documentation and information are essential to an efficient primary source verification process. Collect all relevant materials to verify a healthcare professional’s work history, licensure, education, and board certifications. Complete and accurate information is vital for a successful credentialing process.
4. Use a Centralized System for Managing Credentialing
A centralized system is a key tool in managing the credentialing process efficiently. It ensures that all required documents are received promptly and deadlines are met. This system streamlines the entire process and facilitates effective communication among all involved parties.
5. Embrace Technology to Speed Up Verification
Take advantage of technology to computerize aspects of the credentialing, reducing the required time. For instance, electronically verifying licensure and board certifications can accelerate the process.
6. Prioritize Primary Source Verification
Give importance to the primary source verification process to prevent delays caused by competing priorities. The process can be completed quickly by allocating the necessary attention and resources.
7. Regularly Follow Up with Relevant Parties
Regularly following up with healthcare professionals and relevant parties is essential to keep the process on track and meet deadlines. Communication is vital, and routine check-ins ensure instant resolution of any issues, keeping the process on schedule. In many healthcare organizations, delays often stem from a lack of consistent follow-ups, as administrative staff may be occupied with daily tasks and lack the capacity for regular check-ups.
Book a Call to Learn More About Our Provider Credentialing Services
Credentialing is verifying the qualifications, training, and experience of healthcare providers. The goal is to assess a provider’s competency to deliver care, and this process is crucial to patient safety. Credentialing verifies that a healthcare professional has the proper licenses, certifications, and education to perform their job—their “paperwork.” This process is critical when a new provider joins a group practice or changes jobs. Even experienced providers can have gaps in their credentialing paperwork that delay their ability to treat patients.
How Does Azulity Help With Hospital Credentialing Requirements?
Azulity specializes in healthcare master data management and provider credentialing services, bringing proven expertise in implementing healthcare data solutions and credentialing across the US. Our comprehensive platform ensures consistent patient, provider, location, and claims data synchronization across all systems and departments.
Key features include healthcare MDM, provider MDM, reference data management, credentialing, and provider enrollment. We serve healthcare technology leaders, from CIOs and CDOs to VPs of data platforms and credentialing, helping them eliminate the costly problems of fragmented data systems. Book a call to learn more about our healthcare master data management services today!