Services

PSV - Primary Source Verification Service Packages

Our PSV service can be structured to meet the needs of all types of organizations (HMO, PPO, Hospital, MSO, IPA, Behavioral Health Group, Workers Compensation Group, Specialty product company, etc.) and can be based on NCQA, TJC, URAC or individual requirements.
We have credentialed over seventy-five thousand practitioners, including Physicians (MD, DO), Podiatrists, Dentists, Chiropractors, Physician Assistants, Nurses, Social Workers, Psychologists, Therapists, Acupuncturists, Pharmacists, Audiologists, Optometrists, and many more…

Included with all PSV service packages
  • Data entry of new applications
  • Web-based access to in-process files to review current status of provider verifications
  • Web-based access to completed files where all documents (application, verifications, reports) can be viewed and downloaded from client site.

Expirables

Expiration dates of time-sensitive credentials are monitored and updated on an on-going basis. If the document expires or provider is non-responsive to requests for updateddocuments, TJC Clients are notified prior to expiration of document to meet hospital requirements, and Managed Care clients are notified within 30 days from date of expiration.Expirables include the following:
  • Primary State license
  • DEA license
  • Malpractice Insurance
  • Board Certification

Surveillance Monitoring

For the period between initial credentialing and re-credentialing, CS will monitor sanctions from state license boards and Medicare and will report such actions to client within 15 days. CS will report to the client any and all disciplinary actions taken against their providers, upon discovery or upon notification of such actions, as permitted by law. Such actions include:
  • Loss of license (Primary state license only)
  • State sanctions (Primary state license only)
  • Loss or limitation of hospital privileges
  • Loss or surrender of DEA Loss of malpractice insurance
  • Medicare sanctions
  • Malpractice claim settlements
Sources used to monitor disciplinary issues include state license board minutes, hot sheets, or updates; Medicare sanction monthly updates; and credentialing files for other clients when information received is not confidential, restricted, or otherwise protected.

Client are notified via email at the time a surveillance issue is discovered and the client will also receive a monthly “Surveillance Report” at the end of each month which summarizes any surveillance issues for the past month, or report will indicate “no providers with disciplinary issues”.

Consulting

An extensive array of consulting services is provided by the highly-trained and experienced staff of Credentialing Solutions. Areas which can be included in the consulting package are:

  • Credentialing Program
  • Policies & Procedures
  • NCQA, TJC, or URAC requirements and accreditation standards
  • Accreditation survey preparation
  • Criteria for physician participation
  • Credentialing Files (content, documentation and source of information)
  • Delegation of Credentialing including agreements, process, oversight
  • Internal Staffing Ratios
  • Software and Data Base Management
  • Credentialing Committee
  • Pre-accreditation review
  • Allied Health Practitioners
  • Behavioral Health Practitioners
  • Health Plan compliance & Corrective Action Plans