Why was VeriFide developed?
Both health plans and healthcare providers have expressed concern about the inefficient, repetitive process associated with the verification of provider data during credentialing and re-credentialing/
In order to reduce these inefficiencies, CAQH worked with our member health plans to develop a new solution designed to more accurately, completely and easily verify provider data. Our goal is to reduce the burden for plans and providers inherent in the current process.
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).
How does VeriFide work?
VeriFide leverages data from CAQH ProView®, which is trusted by over 1.4 million providers to report and regularly attest to their professional and practice information.
Supported by an experienced staff, VeriFide uses advanced automated technologies to compare the self-reported provider information to primary sources for accuracy.
CAQH uses the NCQA standardized set of 14 data elements to verify each provider’s professional information:
- 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
Where necessary, VeriFide staffers may contact the provider to confirm specific information.
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.
- 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 reducing 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 use the industry-wide, standard set of NCQA key data elements that must be verified. 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 inefficient and duplicative process, over time VeriFide will align credentialing dates for providers, so that each will have a dedicated recredentialing date among all health plans.
What are the benefits that providers will experience using VeriFide?
When health plans use VeriFide, the providers in their networks should experience:
- A reduction in time from initial credentialing to network participation and payment.
- Reduced outreach to practice staff by multiple health plans.
- Less confusion caused by inconsistent credentialing requirements across plans.
- Dynamic updates to all participating plans designated by the provider.
Please explain the process by which VeriFide will align the provider credentialing dates across the industry.
Each health plan is required by NCQA to re-credential healthcare providers in their network every three years. VeriFide will create an “anchor date.” This is a specific month within the 36-month cycle when the provider will be re-credentialed for all participating health plans.
To achieve this anchor date, each health plan’s re-credential date for a provider will be brought forward (i.e., moved up earlier) several months each year to bring it closer to the anchor date. Since re-credentialing dates for each provider vary greatly from plan-to-plan, it will take several years to achieve this goal. So that providers remain compliant with NCQA requirements during this transition, the re-credential date will be progressively moved earlier, and never moved later.
Once this alignment goal is achieved across the industry, each provider’s data will only need to be verified once, at a specific point in time, every three years. Their information will be shared concurrently with each health plan participating in VeriFide.
Will healthcare providers be charged a fee 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.
What do I need to do to participate in this solution?
Providers currently using CAQH ProView should continue to maintain their data profiles, updating their information and re-attesting when necessary.
When a provider’s contracted health plans begin to use VeriFide for the credentialing process, access to the most up-to-date provider data in CAQH ProView will help speed the verification process.
How can I encourage the health plans with which I contract to use VeriFide?
Please inform your network health plans that you would like them to use VeriFide for the credentialing verification process. They should contact firstname.lastname@example.org.
Where can I go for more information?
Visit the CAQH website for more information about this solution.