A Short Guide to Credentials Verification Organizations

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For health plans, the most important goal is to ensure patient satisfaction by providing high-quality care. To do that, they have to check that the healthcare professionals added to the network meet the necessary qualifications and standards.

Credentials verification organizations (CVOs) can become an integral part of this process by conducting thorough background checks, verifying credentials, and assessing the competence of healthcare providers.

By outsourcing medical credentialing to a CVO, health plans reap a variety of benefits. From reduced administrative burden to faster enrollment, delegated credentialing is key to streamlining provider network management.

Let’s take a closer look at CVOs and the way they work.

What is a Credentials Verification Organization?

A credentials verification organization (CVO) is an independent entity responsible for verifying the qualifications of healthcare providers. They ensure provider competency by:

  •       Running comprehensive background checks
  •       Verifying education, training, licensure
  •       Checking certifications
  •       Exploring work history
  •       Looking for disciplinary actions (if any)

The goal is to make sure that healthcare professionals meet the necessary standards. If they do, they are qualified to provide safe and competent care to patients.

CVOs employ trained professionals who meticulously review each credential to ensure authenticity. By outsourcing this process to a CVO, healthcare organizations can focus on delivering quality care without worrying about the qualifications of their providers.

Overall, the credentials verification organization is a third-party medical credentialing service provider that streamlines your credentialing and enrollment process.

Benefits of Working with a Credentials Verification Organization

Working with a credentials verification organization offers numerous benefits for healthcare organizations, providers, and patients alike.

Save Time and Money

CVOs save health plans time and money by streamlining the credentialing process. Their experienced teams efficiently handle all aspects of verification. 

A group of credentialing professionals arranges a thorough assessment of each credential. This allows healthcare organizations to expedite the onboarding of new providers. As a result, they can help providers enroll quicker and start providing services to the patients.  

The lower administrative burden coupled with less downtime leads to significant time, money, and other resource saving. Meanwhile, health plans avoid hiring professionals who would handle credentialing in-house. Since such professionals earn at least $35,000 a year, these savings can be significant.

Higher Quality Care

CVOs enhance patient safety by ensuring that healthcare providers possess the necessary qualifications. By conducting comprehensive background checks and verifying credentials, CVOs minimize the risk of hiring unqualified providers.

As a result, health plans can provide higher-quality care and increase patient satisfaction. This improves the reputation of the health plan and reduces the number of malpractice claims significantly.

Compliance

CVOs help healthcare organizations maintain compliance with regulatory requirements. They stay updated with evolving industry standards, licensure regulations, and accreditation requirements. This knowledge helps them make sure that providers are continuously monitored and meet the necessary criteria.

With CVO guarding compliance issues, health plans don’t have to worry about fines and downtime. Meanwhile, they don’t have to monitor the re-credentialing schedule.

How to Choose a Credentials Verification Organization

Selecting the right credentials verification organization contributes to a smooth and effective verification process. Here are some key factors to consider when making your decision:

  •       Experience – look for a CVO with a proven track record in the healthcare industry. Consider their expertise in verifying credentials specific to your organization’s needs.
  •       Accreditation – check that the CVO adheres to industry standards and holds relevant accreditations. Look for certifications such as the National Committee for Quality Assurance (NCQA) certification, which demonstrates their commitment to quality and compliance.
  •       Turnaround time – inquire about the CVO’s average turnaround time for completing the credentialing process. Timely verification minimizes delays in provider onboarding and access to care.
  •       Client support – evaluate the level of customer support provided by the CVO. Responsive and knowledgeable support can address any concerns or issues that may arise during the credentialing process.

Speak to a CVO representative personally to get an idea of how smooth your collaboration will be. During the interview find out about their availability. Another issue to discuss is the CVO’s capacity to handle continuous re-credentialing.

Challenges of Working with a CVO

While credentialing verification organizations offer numerous benefits, consider reviewing the potential challenges that may arise when working with them. Here are a few of them.

Delays

One common challenge is the potential for delays in the credentialing process. If you choose a CVO without due experience, connections, and expertise, they may delay credentialing instead of speeding it up.

Miscommunication

 Another challenge is the potential for miscommunication or lack of transparency. When hiring a CVO, you need to establish clear lines of communication. The contract must include guidelines, expectations, and credentialing timeframes.

Accuracy

Maintaining accuracy during credentialing across different healthcare organizations can be a challenge. You would have to choose a CVO that follows standardized processes and maintains up-to-date knowledge of industry standards. Otherwise, you may face errors and delays.  

Outsourcing Credentialing to a CVO

Credentials verification organizations play a vital role in ensuring that healthcare professionals meet the necessary qualifications. By outsourcing the credentialing process to a CVO, healthcare organizations can streamline their operations, enhance patient safety, and maintain compliance.

When choosing a CVO, consider factors such as experience, accreditation, and availability. If you decide to work with a credentials verification organization, you can solve a variety of time-related issues and streamline the credentialing process. 

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