Primary source verification, or PSV in dental credentialing, is a confirmation process that is integral to the success of a dental practice. This process is necessary as it confirms the qualifications and credentials of the dental practitioner. Authenticating credentials and qualifications of a potential dentist or professional helps the practice to safeguard itself, as well as one can safeguard the insurance company and the
Patient.
This verification by dental practice owners is needed to validate that any dental professional who will be recruited into the practice possesses the certification, a valid license, and registration to render services to patients. Primary sources can include relevant degrees or diplomas, specialized training courses, residency certificates, registration with the dental council, or any other specific
requirements as required by regulatory authorities. The verification process using primary sources is a cumbersome and lengthy process. The
validation of credentials can also be outsourced to a dependable partner, but from the primary source is not a simple matter and can be difficult and time-consuming. A dental practice can seek services from a CVO or credentials verification organization. These
agencies can help to manage the primary source verification process.
The NCQA, or the National Committee for Quality Assurance, certifies CVOs who can verify the credentials of dental professionals. Once certified and confirmed, the professionals can render treatment to patients. For the practice, verification helps it to stay compliant and enables faster reimbursement.
The first line of defense for a practice is primary source verification, as it helps to ensure the well-being and safety of the patient. The checking of credentials needs to be done efficiently and with a great deal of accuracy. This helps to filter unsuitable candidates, prevent unwanted delays in reimbursements or claim denials.
It is important to note that the National Committee for Quality Assurance and other accreditation agencies also need to undertake primary source verification. This is required because all insurance companies and other key industry parties use the NCQA standards to execute the credentialing process.
These agencies will not engage with insurance companies that do not conform to expected standards. Likewise, state licensing authorities even need to complete the required primary source verification before interacting with insurance companies.
Before appointing any CVO, the dental practice needs to ensure that these CVOs are NCQA-certified. This offers practice reassurance that all verification is being completed as per NCQA standards. Some practices might not want to depend on outsourced partners and will complete the process in-house. The practice needs to use any advanced or reliable automation software to acquire the required certifications.
Key government and regulatory bodies insist that dental practices undertake the necessary primary source verification when validating the licenses of dental professionals working for the practice. A robust verification process at the beginning of the credentialing process, followed by continuous monitoring, helps the dental practice to stay compliant and well prepared for re-credentialing of the dental professional in a couple of years.
Accuracy and speed are vital parameters that need to be considered for the verification process. By using some advanced automation software and a robust execution process, a dental practice can complete the task at hand efficiently with no additional burden on the
existing dental team. Outsourcing this critical function can also help the team focus on delivering quality care and service to patients.
A vast majority of dental practices have automated PSV processes, since depending on manual and human-intensive processes do not yield the desired speed and accuracy.
Merely selecting and installing an automation platform is not the complete solution.
The dental team or the outsourced partner needs to utilize the capabilities and features of the software to maximize output and efficiency. While switching to automation is a good decision, the team needs to exploit the benefits of it by leveraging the numerous primary
sources that need to be reviewed.
The software must be integrated with relevant sources such as state licensing boards, accredited agencies, etc. In addition, critical board certifications such as NPDB, OIG, and NPI need to be connected. The team needs to perform real-time checks for potential dental professionals with the least manual input.
When deciding on an automation platform, the dental team needs to examine the possibilities of the data getting reviewed and validated within minutes or seconds. The possibility of generating reports for audit purposes or for compliance requirements will be
useful. The team may need proof of the primary source, and the software should be able to capture such proof.
If the practice opts to outsource to a CVO, then the dental team needs to check if the party has access to all data so that the software can be tapped for maximum benefits. This helps in preventing delays in turnaround times, as manual intervention can be avoided.
Automating the PSV process helps to prevent undertaking manual processes while delivering on speed and precision. The software needs to connect to all the relevant entities and government bodies that are primary sources, as it helps to eliminate PSV errors.
A few steps that help to strengthen the process for turnaround times and accuracy are as follows:
