Adva-Net: Making the Right Credentials Verification (CVO) Choice

Impact
EXECUTIVE SUMMARY

Adva-Net is the nation’s first and largest specialty network for comprehensive pain management, post-acute care and addiction recovery within the worker’ compensation industry. Their network includes more than 55,000 healthcare providers at locations across the country. Working with so many providers, the organization needed more accurate, timely primary source verification (PSV) as part of their credentialing process.

THE CHALLENGE

To meet the forecasted credentialing demand, and to ensure that the organization was meeting NCQA standards for
primary source verification (PSV), Adva-Net determined that they would need to hire two additional associates to oversee their PSV process. Unfortunately, due to budgetary constraints, increasing the staff size was impractical. 

Adva-Net was also concerned that key data elements were being overlooked, and the omissions would severely impact
their ability to fully evaluate provider applications, while increasing their susceptibility to audit risks.

THE SOLUTION

Since Adva-Net was already using CAQH ProView® for their provider data gathering process, they decided to choose
VeriFide™ to meet their PSV needs. The network had a strong and positive relationship with the CAQH team and were
pleased to learn that the VeriFide solution utilized the provider data within CAQH ProView.

THE RESULTS
For pass-through data
No Fees
Per provider time savings in data gathering due to increased automation
20 minutes
In the pass-through fees associated with verification data collection
Significant reduction
According to volume
Scalable pricing

Reduced audit vulnerability 

As an NCQA-Certified Credentials Verification Organization (CVO), CAQH offered Adva-Net the assurance they
needed that all regulatory requirements for verified data elements were met, thus reducing their audit vulnerability.

Increased automation and proper staffing and resource allocation

VeriFide automatically imports provider data from CAQH ProView to populate the initial file. Previously, the Adva-Net team spent an estimated 20 minutes per provider simply to access this data manually. Their team was also spending considerable time making outbound calls to providers to address data questions and discrepancies. While much of the VeriFide verification process is automated with primary data sources, the U.S.-based provider outreach team at CAQH will contact providers as needed to clarify data and finalize files.

No data pass-through fees

Adva-Net was pleased that the flat-rate pricing in VeriFide combines data extraction fees for primary source
monitoring and licensing databases, as well as CAQH ProView. Other CVOs charge for access to the data sources
required for PSV, but Adva-Net did not want to pay for overlapping service and data charges.

Pricing Options

With tiered pricing Adva-Net can realize greater savings as their provider network grows, and both on- and off-
shore pricing options are available for even greater savings. The organization is also pleased that they are receiving a
pricing rebate for any “failed files” (those few in which data could not be confirmed).

Learn more about VeriFide. 

As an NCQA-Certified Credentials Verification Organization (CVO), CAQH offered Adva-Net the assurance they
needed that all regulatory requirements for verified data elements were met, thus reducing their audit vulnerability.