Credentialing Standards   /   December 2019

What Does It Take to Become NCQA Certified as a CVO?

What Does It Take to Become NCQA Certified as a CVO?

Whether you are a CVO looking to achieve certification, or a company in need of credentialing who wants to be compliant with NCQA, it’s important to know exactly what it means for a CVO to be considered NCQA Certified. 

This week, we’re excited to welcome guest author Mark Hirschhorn, CredSimple’s Director of Compliance, to talk to us about what this process entails and why it’s so important. 

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CS: So, what is the CVO Certification process? 

MH: The CVO certification process is defined by NCQA as “the process that evaluates the operations of organizations that verify practitioner credentials”. Makes sense, right? It’s critical to ensure that those we entrust to validate our medical professionals are themselves trustworthy organizations who have been given the stamp of approval to provide those services.

The certification process assesses an organization’s performance in the following areas: Internal Quality Improvement Process, Protecting Credentialing Information, and Verifying Credentials. An organization that provides credentialing services can only apply for NCQA certification if they meet a strict set of requirements

CS: Why should a company look for a CVO that is NCQA certified? 

MH: The NCQA CVO Certification shows that a company is committed to playing a vital role in  both patient safety and quality care, by helping to ensure that only qualified and competent practitioners see and treat patients in provider networks. Partnering with an NCQA certified CVO shows your members that you prioritize safety and compliance above all else. 

Partnering with a CVO that has achieved this certification also helps ensure that your organization is meeting the rigorous compliance standards set forth by the NCQA – so you will have peace of mind that this important aspect of your work is being done by a reliable partner.

CS: What does this rigorous process look like? 

MH: Having just successfully undergone this certification process, I can say first-hand that it is very rewarding but intensely challenging, and includes many high points as well as many low points. We found it imperative to have a specific and thorough internal plan of action that included timelines, responsible parties, and priority levels. Without laying out a plan ahead of time, this already daunting process would not be achievable. 

As is typical, this process took us a full year from the time we began preparing until we achieved the certification. It can really be broken down into two parts: before applying for the certification, and after. It’s important to note that when we went through this process, CredSimple was applying to be re-certified. When a company is undergoing certification for the first time, it looks slightly different, but aims to check off the same boxes. 

Before applying, we first discussed with NCQA certification process over a year before our preferred survey date. We recommend this to any CVO looking to go through the same process as it gives your team enough time to adequately prepare. Next, we re-familiarized ourselves with the CVO standards and the Survey tool, provided by NCQA. Although we took the time to make sure we had a handle on these standards, this is truly an ongoing process that we live and breathe every day to ensure we are helping our clients stay compliant. This work continues well beyond the survey date, and every employee of an organization complying with these standards is responsible for making sure they are being followed every day. 

Our next step was to complete a gap analysis, which was a critical component of our success. We compared our current processes and policies to the standards set forth by NCQA to understand where changes and revisions needed to be made in order to be compliant. Just like understanding CVO standards, this is a constant thread through our work that helps make sure we are compliant 365 days a year, not only on the day of our survey. 

Finally, we submitted our application with a desired time frame for the survey, and it was time to get after the second part of the certification process. During this time, the preparation for our survey date never stopped – the slightest oversight or non-compliance could have caused everyone’s hard work to become irrelevant, and derailed our progress towards certification. 

During this time, we continued to check our policies and procedures against NCQA standards. We made sure that we were in complete compliance with NCQA several months prior to our survey date – no one wants to be scrambling at the last minute! 

The most critical step during this time leading up to our survey date was to submit the Survey Tool to NCQA – the submission of this tool is actually the beginning of the survey process, and could potentially prompt an organization to make revisions to processes, policies, and procedures in order to satisfy CVO requirements. Once this tool was submitted, we were ready to welcome our NCQA auditor on site to complete the survey. 

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And there you have it – that’s how CredSimple successfully went through our NCQA Certification this year. If you want to learn more about the importance of working with an NCQA-certified CVO, feel free to reach out anytime by emailing info@credsimple.com.

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