Primary Source Verification (PSV) FAQs for Health Plans

After conducting extensive research with a range of healthcare stakeholders, CAQH determined there was a need to eliminate the costly, duplicative process through which every health plan must individually verify provider data. 

CAQH developed PSV in partnership with health plans. The goal is to consolidate and standardizing the primary source verification, and to align provider re-credentialing dates across health plans. 

Using the same concept as CAQH Provider Data – sharing one set of provider data with multiple organizations – CAQH Primary Source Verification enables participating health plans to share one source of standardized, verified information for each healthcare provider.  

Yes, CAQH is certified as a Credentials Verification Organization (CVO) through the National Committee for Quality Assurance (NCQA). 

CAQH Primary Source Verification leverages CAQH Provider Data, which is accessed by over 2 million providers to report and regularly attest to their professional and practice information. 

Supported by skilled staff, PSV deploys the automated advanced technologies against the self-reported provider information for accuracy.

The web-based client portal offers 24/7 access to view the event status of the verification request.  Any time throughout the research process, plan staff may access the database. They can check the status of a batch request or review the specific provider file elements for reporting on the following elements:

• License to practice
• DEA and CDS certificates
• Education and training 
• Board certification
• Work history
• Malpractice history (NPDB)
• License sanctions (NPDB)
• Medicare/Medicaid Sanctions (NPDB)
• Hospital privileges
• Current malpractice coverage
• Current attestation and disclosure questions
• Office of the Inspector General sanction check
• System for Award sanction check
• Medicare opt-out check
• National Plan and Provider Enumeration System (NPPES)
• Social Security Death Master File (DMF)
• State Exclusions

Where necessary, CAQH Primary Source Verification staffers may contact the provider to confirm specific information. 

CAQH PSV also offers onshore and/or offshore administrative processing, based on health plan requirements.

What differentiates CAQH PSV from other primary source verification solutions is its:

• Seamless integration with CAQH Provider Data.
  • As the leading solution in self-reported data collection for healthcare professionals, CAQH Provider Data is regularly accessed by more than 1.9 million providers to self-report and attest to their professional and practice information.  CAQH Primary Source Verification is able to automatically access the provider data in CAQH Provider Data to begin the verification process.
• Automation with most primary data sources.
  • CAQH Primary Source Verification deploys advanced automated technologies that compare each provider’s information against primary data sources for accuracy.  By eliminating manual processes, it takes less time to work on a provider file, and also reduces the likelihood of human error.  
• Standardization of data elements for quicker credentialing.
  • Each health plan participating in CAQH Primary Source Verificationagrees to limit the verified data elements to the standard set of 14 required by NCQA. This is the information deemed essential for the credentialing process.
• Industry-wide alignment of provider credentialing dates.
  • NCQA requires health plans to re-credential providers at least once every three years.  This process is conducted in different months by different plans, creating duplication for providers contracting with multiple health plans. To reduce this inefficiency and duplication process, over time CAQH Primary Source Verification will align credentialing dates for providers, so that each will have a dedicated re-credentialing date across all health plans.
• Categorized results for quicker credentialing.
  • Each verified data element in the provider file is categorized by CAQH Primary Source Verification, based on the results of the verification; for example, A is valid and current, B is potentially irregular and C is very irregular. This enables each health plan to immediately and automatically route the files needing special follow-up to their appropriate departments, reducing delays.

Yes, CAQH Primary Source Verification queries required databases to support health plans with Medicaid programs: 

• NPPES
• DMS
• State exclusions

Health plans will benefit from:

• Lowered costs from economies of scale for those plans using CAQH Primary Source Verification for the largest number of files. In future years, even greater economies will be achieved by aligning the timing of provider credentialing events across organizations.
• Increased file accuracy and completeness (98.5%) from greater automation, diligent CAQH follow-up and improved provider response to queries.
• A reduced credentialing cycle, returning 98% of the initial files within 8-14-days, and 100% of re-credential files 60 days before the provider’s target data
• Bundle pricing with CAQH Provider Data that includes all pass-through data charges.

Yes, CAQH Primary Source Verification fully integrates with CAQH Provider Data.

Because CAQH Primary Source Verification works with the provider data within CAQH Provider Data, providers must have up-to-date profiles and be included on each health plan’s current CAQH Provider Data roster.

CAQH Primary Source Verification is available as an additional module to CAQH Provider Data, and pricing depends on factors specific to each health plan. Please request a product demo for more information. 

CAQH Primary Source Verification will utilize the data entered into CAQH Provider Data to complete verification, which will continue to be available free of charge to providers.

Visit the CAQH website for more information about this solution.