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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 is tasked with obtaining primary source verification of a provider’s documents on the organizations’ behalf.

Verifying the credentials of medical professionals is critical for patient safety. The credentialing process confirms that any provider interacting with a patient is reliable, trustworthy, and has completed the education and certifications required for that interaction.

During medical credentialing, a CVO verifies the qualifications of a provider to administer care or services for a health care organization. Credentials are documented evidence of the provider’s license, education, training, experience, or other qualifications that confirm their status. The CVO obtains verification of these details from the primary source (for instance, educational institutions and former employers), and maintains the file of information. Without proper medical credentialing, insurance companies may not reimburse healthcare organizations for the services of a provider.

It’s imperative that a healthcare organization have full trust in their Credentials Verification Organization as there is so much at risk. The CVO should be well established with a long track record of performing medical credentialing on behalf of many organizations. Accuracy and timeliness of the submitted information is very important. Additionally, the CVO should have strict security measures in place to protect its sensitive digital data on the providers it credentials.

Things to consider before hiring a CVO

Experience

Does the CVO have significant experience in credentialing different types of healthcare professionals? Have they done so for a variety of delivery settings? Improper or insufficient credentialing has the potential to compromise an organization’s accreditation, their participation with Medicare, and expose them to litigation. Qualifications and experience in a CVO team are essential for the assurance of safe, competent clinical providers, quality of patient care, and risk mitigation.

Accreditation

Has the CVO submitted to the rigorous assessment of the NCQA (National Committee on Quality Assurance) or the Utilization Review Accreditation Commission (URAC)? CVOs that are accredited or certified by these organizations demonstrate excellence in all areas of credentialing, primary source verification, data management, and data security. NCQA and URAC CVO certification is not a one-time accreditation – CVOs must commit to re-evaluation every three years to maintain their good standing.

Not all CVOs are alike

Every healthcare organization is different and none have identical needs. When interviewing a CVO, make sure they design a custom credentialing program that meets all your criteria.

Medical credentialing is extremely time-consuming and expensive for the small provider and large providers alike. Advantum Health’s medical credentialing subsidiary MedAdvantage has managed the credentialing for hundreds of organizations and thousands of providers for more than 25 years. Contact us now for a free evaluation.