Hospitals, health systems, managed care organizations, clinically integrated networks (CINs), accountable care organizations (ACOs), ambulatory surgery centers, large medical groups, and a variety of other organizations charged with performing provider credentialing activities are often limited on staff, time, credentialing expertise or experiencing inordinate credentialing volume that may prompt them to consider delegating part or all of their credentialing activities to another organization.
Delegated credentialing requires the delegator and the delegatee to enter into a formal agreement that outlines the functions delegated, the primary sources used, the responsible parties for different parts of the credentialing process and general legal protections and remedies typically found in contracts. The requirement for a delegated agreement generally stems from requirements for delegation of credentialing set forth by the National Committee on Quality Assurance (NCQA), the Joint Commission (TJC) and the Utilization Review Accreditation Commission (URAC), as well as other accreditation bodies. Moreover, delegation agreements are best practiced in the health care marketplace and serve as a mechanism to clearly identify roles and responsibilities of both parties, processing timeline expectations, legal protections and compensation for delegated services.
Credentials Verification Organizations (CVOs) provide expert credentialing services to the health care industry by assisting organizations in meeting and exceeding the plethora of regulations, accreditation standards, and organizational-specific requirements. CVOs assist organizations in ensuring clinicians are who they say they are, received the education and training they have reported they’ve received, and have no history of adverse action taken against their license or other aspects of their practice. In short, CVOs can and do assist organizations in assuring, safe, competent, quality providers for the patients and communities their Clients serve.
When considering delegated credentialing with a CVO, be aware that not all CVOs are created equally.
It is important to ask CVOs for client references and perform research to ensure they are a reputable organization that consistently produces efficient, fully-compliant credentialing functions on behalf of their Clients. ‘Gold star’ CVOs are accredited by NCQA or URAC and are denoted as such on NCQA and URAC’s websites. NCQA-certified or URAC-accredited CVOs voluntarily subject their credentialing services and program to rigorous surveys every 24 to 36 months to ensure they offer (and produce) credentialing services for clients that consistently meet and exceed all relevant regulatory, accreditation and legal requirements.
PCVS is a national, not-for-profit, dually-assessed CVO by NCQA and URAC, one of only seven in the United States. We have proudly served our clients since 1992, providing gold star credentialing services for tens of thousands of practitioners. PCVS’s team of knowledgeable, experienced credentialing professionals can assist your organization in tailoring a delegated credentialing agreement that meets your needs. Contact us today to learn about how PCVS can assist with your organization’s credentialing needs.