Primary Source Verification

Primary Source Verification (PSV) is a critical step in healthcare provider credentialing. The process can be a long one – often taking between two and four months to complete the credentialing cycle. This can create a billing and reimbursement burden for hospitals and practices that have engaged new providers. For many health plans conducting PSV in-house, the existing process can be cumbersome, involving significant data entry and manually checking multiple sources.

Additionally, the current PSV model requires each organization to conduct PSV separately for every provider they credential, duplicating the same process for that provider as other health plans, health systems and health plans. This process must also be repeated each few years when the provider undergoes re-credentialing.

Without a consolidated, standardized way of completing PSV to meet varied accreditation and compliance requirements, healthcare organizations will continue to engage in overlapping and redundant processes to credential providers.

CAQH is working with its member health plans to improve the PSV process, through:

  • Centralization to eliminate redundant functions and create economies of scale.
  • Standardization to drive improvement in data quality and reduce costs.
  • Alignment of provider re-credentialing cycles across health plans.
  • Automation of functions to reduce turnaround time and labor.

CAQH is now certified as a NCQA credentials verification organization (CVO) and is developing a dramatically different, collaborative solution to streamline the primary source verification process for the healthcare industry. The CAQH PSV solution will integrate with CAQH ProView® and be available to health plans later this year.