Have you ever found yourself asking primary source verification (PSV) questions like: “Which verifications need to be checked to ensure a provider is properly credentialed to work at your ambulatory care center or clinic?” If so, this post is for you!
After a provider fills out an application, the next step in the credentialing process is verifying the self-reported information against the originating or primary source. This is referred to as Primary Source Verifications or PSVs. For example, if an organization is validating a provider’s medical license, the primary source for that piece of data is the state’s medical board or department of health. In this post, we’ve compiled a guide for PSVs that explains the What, Where, Why and How of each PSV.
The ABCs of PSVs
| What | National Provider Identifier (NPI) |
| Why | An NPI is a provider’s unique identifier, so if you have multiple Dr. John Smiths working within your organization, this ensures the data records do not confuse the Smiths. The NPI Registry searches the provider’s information in the National Plan Provider Enumeration System (NPPES). All information produced by the NPI Registry is provided in accordance with the NPPES Data Dissemination Notice. |
| Where | National Plan Provider Enumeration System (NPPES) in the NPI Search Registry, which is updated daily. |
| URL | https://nppes.cms.hhs.gov/NPPES/Welcome.do |
| How | Search the NPPES by name for the doctor you are credentialing. |
| Shortcut | andros tracks all of its provider data using the NPI, so you don’t have to search NPPES manually. |
| What |
Federal and State Sanctions |
| Why | Sanctions are any penalty, punitive or disciplinary action imposed on providers when they are found in violation of a law or regulation governing the practice of medicine. It’s important to know the background of the doctors you are recommending to your patients. |
| Where |
Office of the Inspector General (OIG), System of Award Management (SAM) and General Services Administration (GSA) |
| URL | |
| How |
Download the file every month, open the document in your favorite spreadsheet tool and search for the names of each of your providers or search online one at a time. |
| Shortcut |
andros will do this for you and alert you automatically if any of your providers’ names appear. |
| What |
Medical Licensure |
| Why |
Increased public demand for protection and the growth in the number of fraudulent providers over the last 20 or so years has resulted in tougher and more complex licensing boards and statutes, though each state can vary vastly. The trend is towards uniformity among licensing boards nationally. |
| Where |
State medical board and department of health |
| URL |
Each state has a different board. For example, Google, “New York Medical Board.” |
| How |
Search the state medical board and/or the department of health. |
| Shortcut |
andros will track this information for you. |
| What |
DEA Controlled Substance |
| Why |
Physicians, nurses, PAs and other providers that write prescriptions must be registered with the Drug Enforcement Agency (DEA). In addition, some states have their own board that issues permits to providers to write prescriptions for controlled substances. The DEA data set is controlled by the National Technical Information System (NTIS). You’ll need an authorized account to do this verification. |
| Where |
National Technical Information System (NTIS) and state CDS |
| URL | |
| How |
Set up a paid account with the NTIS at DEANumber.com. Then search the data set for each provider that you need to credential. You’ll want to make a note of the date when your provider’s DEA registrations expire. |
| Shortcut |
andros will track this information for you. |
| What |
Malpractice |
| Why |
This verification is designed to improve healthcare quality, protect the public and reduce healthcare fraud and abuse. The National Practitioner Databank contains information on medical malpractice payments and certain adverse actions related to healthcare practitioners, entities, providers and suppliers. |
| Where |
National Practitioner Databank (NPDB) |
| URL | |
| How |
Submit a query through the Integrated Querying and Reporting Service (IQRS). |
| Shortcut |
andros will check the NPDB report to verify that there were no actions involving a provider and that there is no record of a medical malpractice payment settled on behalf of a healthcare provider. |
| What |
Disciplinary Actions |
| Why |
This verification is designed to improve healthcare quality, protect the public and reduce healthcare fraud and abuse. |
| Where |
NPDB, state medical board and department of health |
| URL | http://www.npdb.hrsa.gov/ and search the state medical board and the department of health |
| How |
Submit a query through the Integrated Querying and Reporting Service (IQRS) as well as query the state medical boards and the department of health where that provider is licensed. |
| Shortcut |
andros searches the state(s) medical board and the department of health the provider is licensed in for discrepancies. |
| What |
Board Certification |
| Why |
Board-certified physicians advance the standard of specialty medical care nationwide for improved outcomes and better patient experiences. In addition, patients benefit from a physician’s focus on the core competencies for quality of care. |
| Where |
American Board of Medical Specialties (ABMS) / AOA |
| URL | http://www.abms.org/contact-us/ |
| How |
The ABMS physician certification database is the most widely respected resource for board certification information. This info is recognized by the Joint Commission, National Committee for Quality Assurance, URAC and other agencies as satisfying primary source verification as needed by professional organizations. |
| Shortcut |
andros accesses the ABMS and verifies the information after it has been uploaded, matched and thoroughly checked for quality and accuracy. |
| What |
Education |
| Why |
At the time of initial credentialing, you’ll want to verify that the provider you’re credentialing has completed their medical education and training. You can do this by contacting the school directly or by purchasing the AMA Physician Masterfile, which includes information on the education, training and professional certification of virtually all MDs, DOs and PAs in the United States. |
| Where |
American Medical Association (AMA) |
| URL | http://www.ama-assn.org/ama |
| How |
Search for and purchase the AMA Physician Masterfile. |
| Shortcut |
andros partners with the AMA and checks the Physician Masterfile to verify a provider’s education. |
| What |
Criminal Background Check |
| Why |
Depending on your organization’s review process, it can be important to do a standard background check on your perspective providers. A background check verifies all of the following: SSN validation, Address History, Sex Offender List, Terrorist Watchlist, National Criminal Search and county criminal searches. |
| Where |
Checkr or another background service |
| URL | https://checkr.com/pricing |
| How |
Submit each provider to a background check agency such as Checkr. |
| Shortcut |
andros partners with Checkr for real-time background checks and automatically uploads the background check to your provider profile on the andros platform. |
Further Resources
For those new to the world of medical credentialing, we also recommend becoming familiar with the NCQA and JCAHO guidelines. You can learn more about the NCQA standards by taking a look at their credentialing fact sheet or reading this great summary authored by the National Association of Medical Staff Services (NAMSS). For the Joint Commission standards on credentialing, we suggest reading their recommended credentialing practices. Another great resource put out by NAMSS is a comparison of the NCQA and JCAHO credentialing guidelines.
So there you have it: the ABCs of PSVs. Once you get started down this road, you’re going to realize you’re doing a lot of manual and repetitive work and you’ll probably start asking: “Is there a better way to do this?”
We believe there is! We’re andros and this is what we do. We make it easy for companies like yours to meet and exceed NCQA and JCAHO credentialing standards and practices. By partnering with primary source organizations and compiling, organizing and continually updating the data, we take care of all the PSV work so that you can focus on running and growing your business.
Whether you are new to the medical credentialing process or a veteran, andros can help your organization find the most efficient way to manage credentials and provider data.
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