Category: Press Room

In addition to all of the considerations clinicians face in the practice of medicine, starting the credentialing process can seem like an overwhelming administrative endeavor, fraught with delays and frustration.  Keeping some key fundamental points in mind will assist in prioritizing and finalizing credentialing efforts. Hospital/Health System Based on your specialty, determine whether or not […]

There are many important considerations when starting a new practice or entering into a new payer agreement that need to be taken into consideration.  Knowing when to start the hospital or insurance payer credentialing process is essential to proactively assuring timely reimbursements are flowing into a medical practice. Yet, it is often one of the […]

Consideration of which insurance payers to participate with requires informed decision-making as a first step. Reserving time and effort to contract and enroll with only those payers who provide competitive and equitable reimbursements, represent a substantial size of the patient population served, and offer financial incentives for the containment of cost and the delivery of […]

Starting a new medical practice, or recruiting new physicians (or other clinical practitioners) to an existing practice is riddled with several administrative challenges. The primary one being proactive, timely application for medical staff hospital privileges and insurance enrollment and credentialing. These two factors alone directly correlate to a new practitioner’s ability to care and bill […]

Today, the act of ‘credentialing’ is defined as verifying a clinical practitioner obtained the education and training that qualifies him or her to deliver clinical care to patients. We also consider verification of current requisite licensure, professional liability coverage, criminal background checks and sanction monitoring, among other verifications, to be part of the credentialing process. […]

PCVS is pleased to announce it has received full accreditation status by the Utilization Review Accreditation Committee (URAC) as a Credentials Verification Organization (CVO) through January 1, 2021. Full URAC CVO accreditation means PCVS obtained 100% compliance and has been assessed and scored against more than 130 credentialing quality, security, and process standards. Credentialing is a […]

The Patient Protection and Affordable Care Act (PPACA) put in place several health care industry provisions to mitigate fraud and abuse in the Medicare and Medicaid programs, with an ultimate goal to contain rising health care costs. The final rule, 42 CFR 455.436, published June 1, 2016, requires states and their Medicare/Medicaid agencies to conduct federal […]

In the United States today, there are roughly 80 Credentials Verification Organizations (CVOs) that is certified by the National Committee for Quality Assurance (NCQA) or accredited by the Utilization Review Accreditation Commission (URAC). Of those 80 CVOs, only seven are dually-assessed by both NCQA and URAC. Professional Credential Verification Service (PCVS) is one of them. […]

Previous to the Healthcare Quality Improvement Act (HCQIA) of 1986, there was no single, national source available to organizations required to perform credentialing to assess whether or not their practitioners had previous actions taken against them related to medical malpractice settlements, adverse privileging actions, state and federal licensure actions, Medicare exclusions or debarment, among other […]

Episodic and ongoing practitioner sanction monitoring is required by the National Committee on Quality Assurance (NCQA), as well as other accrediting bodies. It is also considered a best practice in any credentialing program. Sanction monitoring typically involves confirming the absence or presence of Medicare and Medicaid exclusions, and adverse state and federal licensure actions, contractual […]