Primary source verification is the meat of the credentialing process and because it has traditionally been based on time-intensive manual work and tedious data entry, it has been a resource-intensive and delay-inducing process.
Why is Primary Source Verification so important to health plans and telehealth and behavioral health organizations?
Your provider network is a major part of the member and patient experience and, therefore, brand. Its quality and adequacy determines their happiness and health. It affects how they think and talk about your brand.
Your network also affects revenue. Revenue can be affected by benched providers (because of initial credentialing delays or due to a recredentialing backlog) or, for new networks, by extended network spin-up timelines or network adequacy issues.
And once a provider is credentialed, regularly monitoring DEA, sanctions, malpractice and state license data, as well as medicare opt-out, is key to staying on top of your network in order to make proactive decisions about providers as issues arise.
The current Primary Source Verification paradigm is inefficient and resource intensive. But it doesn’t need to be.
Whether you’re doing this in-house or using a legacy CVO to conduct your PSV work, this process is heavily dependent on people performing time-consuming manual tasks and repetitive data entry.