VeriFide FAQs for Health Plans

Why was VeriFide developed? 

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 VeriFide 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 ProView® – sharing one set of provider data with multiple organizations – VeriFide enables participating health plans to share one source of standardized, verified information for each healthcare provider.  

Is CAQH a certified credentials verification organization (CVO)?

Yes, CAQH is certified as a Credentials Verification Organization (CVO) through the National Committee for Quality Assurance (NCQA). CAQH received full NCQA certification for all 14 credentialing elements in February 2016.

How does VeriFide work?

VeriFide leverages data from CAQH ProView, which is accessed by over 1.6 million providers to report and regularly attest to their professional and practice information. 

Supported by skilled staff, VeriFide 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, VeriFide staffers may contact the provider to confirm specific information. 

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

How is VeriFide different from other primary source verification solutions?

What differentiates VeriFide from other primary source verification solutions is its:

  • Seamless integration with CAQH ProView.
    • As the leading solution in self-reported data collection for healthcare professionals, CAQH ProView is regularly accessed by more than 1.6 million providers to self-report and attest to their professional and practice information.  VeriFide is able to automatically access the provider data in CAQH ProView to begin the verification process.
  • Automation with most primary data sources.
    • VeriFide 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 VeriFide agrees 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 VeriFide 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 VeriFide, 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.
Does VeriFide support PSV efforts for Medicaid Programs? 

Yes, VeriFide queries required databases to support health plans with Medicaid programs: 

  • NPPES
  • DMS
  • State exclusions
What are the benefits that health plans will experience using VeriFide?

Health plans will benefit from:

  • Lowered costs from economies of scale for those plans using Verifide 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 147-days, and 100% of re-credential files 60 days before the provider’s target data
  • Bundle pricing with CAQH ProView that includes all pass-through data charges.
Will VeriFide integrate with CAQH ProView?

Yes, VeriFide fully integrates with CAQH ProView.

Do all the healthcare providers on my roster need to participate in CAQH ProView? 

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

How much will VeriFide cost?

VeriFide is available as an additional module to CAQH ProView, and pricing depends on factors specific to each health plan. Please request a product demo for more information. 

Will providers be charged to participate in this service?

VeriFide will utilize the data entered into CAQH ProView to complete verification, which will continue to be available free of charge to providers.

Where can I go for more information? 

Visit the CAQH website for more information about this solution.

See a Demo

Type
Audience