Provider credentialing ensures that healthcare practitioners are qualified, competent, and properly licensed to deliver safe, high-quality care. It is a multi-step process hospitals and healthcare organizations must undergo to assess and verify a practitioner’s qualifications before they can see patients and provide care.
What is primary source verification?
To protect patients and prevent negligent credentialing lawsuits, hospitals and healthcare facilities use primary source verification (PSV) as a credentialing industry standard.
PSV is a crucial step in healthcare credentialing and enrollment processes where information provided by healthcare professionals or entities is directly verified from the original or primary source. This ensures accuracy and reliability of information related to qualifications, licenses, certifications, education, training, and professional history before granting privileges or enrollment in healthcare networks.
Why is primary source verification important?
PSV protects the provider, healthcare organization and – more importantly – the patient. It helps organizations mitigate risks, uphold regulatory compliance, and maintain the integrity of their provider networks by confirming that providers meet the necessary qualifications and standards.
Failing to credential and verify a provider accurately can jeopardize patient safety and lead to malpractice lawsuits due to negligent credentialing.
What credentials require primary source verification?
The Joint Commission, the primary accreditor of most U.S. hospitals and health systems, requires accredited healthcare organizations to use primary sources to verify certain credentials, including:
- Medical school diplomas
- Specialty training or residency certificates
- Licenses to practice
- Registration with a medical or dental council or any other credential required by law, regulation or hospital policy
- Any credentials issued by recognized education or professional entities as the basis for clinical privileges
The Joint Commission does not require other credentials, such as professional history, letters of recommendation, criminal background checks, identification verification, immigration, and financial documents to be verified from the primary source, unless required by hospital policy.
What’s considered a primary source?
A primary source is the body, organization, or person who issued the information under review. These sources would have direct knowledge of the validity of information stated by the practitioner.
Alternatively, a designated equivalent verification source specified by your accreditation choice (for example, The Joint Commission) can be used. In some situations, the primary source may rely on a third party to provide verification of a practitioner’s credentials, such as when a state licensing agency designates verification through AIM Docfinder as primary source.
Issuing body
When it comes to licensure, certifications, education, training history, and professional affiliations, the issuing body is the primary source. These can include:
- Federal and state government agencies
- Licensure
- Sanctions
- National Practitioner Data Bank (NPDB)
- State certifications
- Controlled substance/narcotics certification
- Background checks
- Criminal history
- Military personnel records
- Education institutions
- Medical school and post-graduate training records
- Hospitals/Employment
- Experience and work history
- Privileges granted
- Professional associations
- Affiliations
- Professional certifications
- Individuals
- Whenever information supplied by a provider involves a personally written peer reference or confirmation, you must locate and communicate directly with that individual to verify the accuracy of what they wrote and confirm that the peer had the necessary familiarity with the provider to make a professional assessment or recommendation.
Can you obtain verification from a non-primary source?
In some cases, you can get verification from a source that is not the primary source but is still considered its equivalent (i.e., as accurate as the original issuing body).
The Joint Commission accepts these (and other) designated equivalent sources for credentials verification:
- The American Medical Association (AMA) Physician Masterfile for verification of a physician’s U.S. and Puerto Rican medical school graduation and postgraduate education completion; this database contains provider data which has been obtained directly from the primary sources
- The American Board of Medical Specialties (ABMS) for verification of a physician’s board certification
- The Educational Commission for Foreign Medical Graduates (ECFMG) for verification of a physician’s graduation from a foreign medical school
- The American Osteopathic Association (AOA) Physician Database for pre-doctoral education accredited by the AOA Bureau of Professional Education, post-doctoral education approved by the AOA Council on Postdoctoral Training, and Osteopathic Specialty Board Certification
- The American Academy of Physician Assistants (AAPA) Profile for physician assistant education, provided through the AMA Physician Profile Service
- The Federation of State Medical Boards (FSMB) Disciplinary Action Databank for all actions against a physician’s medical license
In addition, some organizations will designate an agent to handle verification requests on their behalf.
A designated equivalent source, if available, can be a convenient way for credentialing professionals to quickly verify a provider’s information while having complete confidence in that source’s accuracy.
What is the credentialing verification process?
The organization doing the credentialing contacts the original source to verify that the information is accurate as represented by the applicant.
Typically, you would obtain verification inwriting, through telephone verification, or through a website.
If you are verifying information with a primary source by phone, including the following details will provide a well-documented record of the call:
- Name of the organization
- Date contacted
- Person contacted
- Phone number of person contacted
- Questions asked
- Question responses
- Name of the person responding
- Name and signature/initials of person collecting the verification information
- Date the verification was completed
When verifying credentials through the website of a primary or designated equivalent source, be sure to capture the following information if the printed copy of the webpage will serve as your record:
- Practitioner’s name and any relevant identifying information (e.g., date of birth)
- Confirmation verifying the practitioner’s credential and related details
- The URL of the webpage
- Date verified
- Initials of the individual conducting the verification
When should you use a secondary source?
You won’t always be able to verify information directly from a primary source.
If your attempts to verify the credentials using primary sources are unsuccessful, you should verify education and licensure through the licensing board or a designated equivalent source.
Secondary source verification can include:
- Written statements from the leadership of successor organizations
- In cases of a hospital closure, determining where the original documents were sent
- Contacting other hospitals in a closed facility’s area to see if anyone on staff can offer primary source verification
Whether you verify provider information from original sources, use a designated equivalent, or uncover a knowledgeable secondary source, going the extra mile to ensure the accuracy of provider credentials will safeguard the integrity of your credentialing process, protect your patients, and reduce your legal risk.
By outsourcing primary source verification to a Credentials Verification Organization (CVO), your healthcare organization can streamline and safeguard the primary source verification process, reducing the likelihood of noncompliance, inaccuracy, and increased audits that drain financial resources.
