Professional Credential Verification Service (PCVS) is one of only seven credentials verification organizations (CVOs) in the United States accredited by the Utilization Review Accreditation Commission (URAC) and certified by the National Committee on Quality Assurance (NCQA). These ‘gold star’ ratings assure PCVS Clients that they receive the highest level of accurate, compliant and secure primary source verification and ongoing monitoring services available in the marketplace. However, PCVS’s dually-assessed status by URAC and NCQA may leave some potential clients wondering if PCVS’s services are a good fit for them, specifically if their organization is a rural, acute care, or multi-hospital health system.
While PCVS is dually-assessed by URAC and NCQA, it also abides by the current medical staff/credentialing standards prescribed by The Joint Commission (TJC). Generally speaking, there are many commonalities among URAC, NCQA, and TJC credentialing standards. Yet, there are also some very distinct differences.
NCQA credentialing standards place a strong emphasis on the quality of the process. As such, NCQA is highly prescriptive in requiring specific time frames for the validity of primary source verifications, many of which must be less than 120/180 days old at the time of the credentials committee’s review and approval decision. Placing time frames on primary source verifications ensures the credentials committee is making recommendations and/or approvals on applicants for whom they have recent, current information. NCQA also considers the credentials committee to be the decision-making, approval body for initial and recredentialing decisions.
Similar to NCQA, URAC also places an emphasis on the timeliness of primary source verifications, ensuring the credentials committee is making recommendations based on current primary source verification information. In addition, URAC is highly focused on development and implementation of credentialing standards that seek to protect the confidentiality and security of credentialing information, which are generally protected under federal and state peer review statutes. Like NCQA, URAC considers the credentials committee to be the decision-making, approval body for initial and recredentialing decisions.
TJC employs similar primary source verification requirements, but is less prescriptive as it relates to the timeliness of primary source verifications, fundamentally allowing individual medical staffs to define in their bylaws, policies, and procedures, what is acceptable and what is not regarding the age of primary source verifications. Unlike NCQA and URAC, TJC does not consider the credentials committee to be the decision-making, approval body. While medical staff bylaws vary from hospital to hospital, generally speaking the credentials committee makes recommendations for approval to the medical executive committee, who in turn makes recommendations to the Board for approval. However, most medical staff bylaws do allow for an abbreviated approval process, based on unique patient or hospital need, and are often approved under the umbrella of ‘temporary privileges.’
Regardless if an organization applies NCQA, URAC, or TJC credentialing standards, or a combination of all of them, organizations can be assured that PCVS will meet and exceed credentialing needs. Our highly experienced team of credentialing professionals provide CVO services to a wide variety of clients (hospitals, health systems, managed care, ambulatory surgery centers, independent provider associations, etc.) and can design credentialing services tailored to each organization’s specific needs, scope, and accreditation standards.