What Does a Credentialing Verification Organization Do?

What Does a Credentialing Verification Organization Do?

A credential verification organization (CVO) is a third party that verifies and validates health care providers’ information.

Outsourcing credentialing services can help you manage your resources and increase customer satisfaction. Here are some things credentialing companies do:

Provider Credentialing:

Provider credentialing entails verifying a healthcare provider’s eligibility or qualifications to participate in insurance networks.

A credentialing organization collects and reviews details such as the provider’s training, education, licensure, and professional history. Credentialing can be intensive for new practices since contracting paperwork is separate. 

The CVO requests copies of the following documents to determine authenticity:

  • Diplomas
  • Transcripts
  • Licenses
  • Certifications

During application, healthcare providers can provide information about the services they offer, the location of the practice, and insurance coverage. The CVO can also contact licensing boards and issuing institutions to ascertain whether the information provided is accurate.

Provider credentialing helps healthcare providers establish themselves as trusted and credible partners to insurance companies.

Provider Enrollment:

Provider enrollment is the process of registering with an insurance company to become a provider and receive reimbursement for services rendered.

If you want to participate in private insurance carriers, Medicaid, or Medicare, a credentialing company can assist you in provider enrollment.

A CVO needs documents like a provider’s education, licensure, malpractice insurance, training, and education credentials to facilitate the enrolment process.

This process enhances compliance with insurance companies and government programs since credentialing companies review supporting documents thoroughly before approval.

By enrolling with multiple payers, providers can generate more revenue in their practices and increase the number of patients. Proper enrollment lowers the chances of insurance companies denying or delaying your payment.

Staff Recruitment Services:

If your practice wants to hire new talent, take advantage of credentialing services. CVOs conduct criminal background checks on healthcare providers you intend to employ. They can also conduct drug screenings to increase the chances of getting the right staff for your practice.

CVOs use cloud-based software and reporting to monitor the ongoing credentials of healthcare experts to determine if they are up to date. Credential staffing and recruitment services can be useful for clearing a backlog of applications.

Re-credentialing and Maintenance:

Re-credentialing and maintenance refer to verifying and updating your current information. Recredentialing revalidates information for Medicare and Medicaid to boost revenue collection.

This process can be helpful in addressing deletions to prevent claim rejection. Credentialing experts can assist healthcare providers in submitting updated applications and verifying ongoing education and training.

CVOs provide maintenance plans for licenses, drug enforcement administration, and malpractice insurance to mitigate risks related to liability and malpractices.

Request for re-credentialing and maintenance when you’re planning to bring in a new provider. These services can also be helpful when carriers need new or updated details.

Consulting and Training:

Credentialing organizations offer training services to help you navigate the complex credentialing process. These experts can teach you how to use credentialing software and other platforms to streamline tasks and improve efficiency in your practice. If you want to learn more about medical practices and compliance, a CVO can educate you.

You can also consult with a CVO to know more about the steps for completing an application, primary source verification, and maintenance requirements. Some credentialing professionals provide risk management consulting services to manage malpractice claims.

They can also identify issues within the credentialing process and improve them for better results.

Credentialing Companies: Comprehensive CVO Services:

A credentialing verification company offers provider enrollment and credentialing. These organizations offer staff recruitment, consulting, and training, among other services. The cost of these services varies, depending on the technology used and the type of services rendered.

Experts can facilitate the process from application and verification, to review and approval. Get comprehensive services from reputable credentialing companies.