Primary Source Verification: The Foundation of Credentialing

Your telehealth organization is only as strong as its reputation — and that starts with the quality of clinicians you hire on to provide virtually-enabled care. Understanding primary source verification is a crucial step to ensuring the safety of your patients, and protecting your organization from revenue losses or malpractice liabilities related to mistakes in the credentialing process.

Your telehealth organization is only as strong as its reputation — and that starts with the quality of clinicians you hire on to provide virtually-enabled care. Understanding primary source verification is a crucial step to ensuring the safety of your patients, and protecting your organization from revenue losses or malpractice liabilities related to mistakes in the credentialing process.


What is Primary Source Verification? 


According to The Joint Commission, primary source verification is the process of “confirming that an individual possesses a valid license, certification or registration to practice a profession.” This process includes obtaining a provider’s credentials directly from a primary source, such as former employers, government agencies, universities, and professional organizations. 


Primary source verification is different from provider enrollment. In fact, the primary source verification process occurs before an applicant or clinician is officially hired in a healthcare setting. Once a medical provider is granted care privileges, he or she then begins the provider enrollment process through managed health plans to gain approvals to deliver clinical care and qualify for reimbursement. In either case, primary source verification serves as the foundation of the credentialing process.     


Some of the information verified through primary source verification include: 


  • State medical licenses
  • Military board personnel  
  • Federal and state DEA certificates 
  • Board certifications 
  • Medical education 
  • Training and residency programs
  • Medical malpractice history
  • Work history  
  • Hospital affiliation 


Accreditation agencies such as the federal Centers for Medicare & Medicaid Services (CMS), the National Committee for Quality Assurance (NCQA), as well as The Joint Commission all  require primary source verification. A healthcare organization that chooses not to follow the standards set by CMS, for example, will lose its ability to be reimbursed for medicare or medicaid services — a significant portion of revenue for many healthcare groups.


By engaging in direct correspondence, documented telephone verification, secure electronic verification from the original verification source, or by gathering reports from credentials verification organizations (CVOs), a health organization ensures that all information is current and valid in accordance with state laws and medical regulations. 


These regulations and standards can vary. For example,The Joint Commission only requires healthcare organizations to complete primary source verification for medical school diplomas, specialty training or residency certificates, medical licenses, or professional credentials issued by a reputable professional association. Yet, other healthcare organizations and payers’ policies may require additional authentication for a range of identifiable documents from recommendation letters to financial records.  




Preventing Credentialing Roadblocks   


While practitioners play an essential role in gathering information to help kick off the credential process, it falls to the responsibility of the accredited health organization (usually a hospital administration or human resources function) to complete the primary source verification process before granting privileges, not the individual clinicians.

It is not uncommon for administrative teams to run into credentialing roadblocks during the primary source verification process. There are instances when a medical school or professional association has closed its doors, for example. Over time, some records get lost or destroyed in cases of fire or natural disasters. Other providers may have practiced medicine across international borders.


In these cases, credentialing teams must perform due diligence to seek out a secondary source and document their attempts at verification throughout, including through successor organizations, peer professionals, or hospitals and schools that may have obtained the data in transition. 


There are other challenges, too. All of this verification takes time — a lot of time. The entire credentialing process can take anywhere from 90 days or more before a healthcare provider receives his or her privileges. Any hold up in the primary source verification process only extends the timeline.  


In the meantime, the hours dedicated to verifying provider credentials with primary source verification creates a resource-burden for administrative staff, especially when considering that dozens of clinicians may be entering the hiring or renewal process at any one time. 


With the rapid growth of telemedicine organizations, lagging timelines only serve to hinder growth. While awaiting the green light, providers are stuck in the process, unable to deliver care, or contribute to the clinical group’s revenue cycle. 


While manual verification processes have evolved with the rise of electronic databases with licensing and certification information, such as with the NCQA, the lack of a standard process and administrative training to keep pace with the telemedicine revolution has created snags in the process.    



A Faster Way to Verify Credentials 


Primary source verification doesn’t have to be that hard. As an innovative CVO, Medallion is eliminating administrative burdens with an automated end-to-end credentialing solution. We provide the fastest way to onboard new providers through our primary source verification, ongoing monitoring, and streamlined committee process — built right into our state-of-the-art software platform. 


If you’re interested in accelerating the primary source verification process for your telehealth company, request a demo today. 


Want to receive emails?

Sign up to get an email every time a new blog is published!