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Primary Source Verification

Primary Source verification is an important step in the credentialing process. It helps healthcare organizations to maintain qualified medical providers, improve quality of care and decrease liability risk.

 

What is Primary Source Verification? 

Primary Source Verification refers to verfiying a health care provider (Typically MDs, DOs, NPs,PAs etc) credentials such as education, training, certification, licensure etc with the Primary source. Primary source verification generally includes a combination of online verification with the direct source, telephone confirmation and other direct correspondence.

 

 What is the difference between Credentialing & Primary Source Verification?

Credentialing typically refers to insurance credentialing / medical credentialing i.e getting on insurance panels with insurance companies so that you can bill as in-network. Primary Source Verification (Sometimes referred as Primary Source credentialing) is verification of provider credentials directly with primary source.

 

Why do a health care organization need Primary Source Verification?

Sometimes people tend to use illegal ways of obtaining degree certificates so that they can carry unlawful work without getting caught. Utilizing fake degrees from colleges or universities, fraud work experience certification, fraud license, lying in resumes to get employment are some examples. There were multiple scenarios where some people have provided medical care and performed surgeries despite no real qualifications. This carries a significant liability risk on the health care organization. Due to these reasons many health care organizations make it their policy never to employ a provider or physician without appropriate credentialing via primary source verification. 

 

What are the typical credentials verified through a primary source verification process?

·        State medical licenses

·        Federal and State DEA certificates

·        State Controlled Substance Registration

·        Board certifications

·        Medical education 

·        Training programs (Internship, Residency or Fellowship etc)

·        OIG, AMA, AOA, ABMS, ABIM 

·        EPLS/SAM

·        National Practitioner Data Bank

·        Medicaid Sanctions list

·        Medicare Opt Out list

·        Medicare Preclusion List

·        NPI

·        ECFMG

·        Medical Malpractice loss runs report

·        Work History

·        Hospital affiliation verification