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NCQA Certified CVO Services | CredentialsOnLine FAQ

CredentialsOnLine - Streamlined - Centralized -
Provider Verification Services.

CredentialsOnLine is a centralized provider verification service providing verification for over twenty different provider types for the healthcare industry. We provide verification services using state-of-the-art technology to improve efficiency, accelerate the process and reduce costs.

CredentialsOnline makes a once confusing and complicated application process more manageable.

What are some of the benefits of using CredentialsOnLine?

• CredentialsOnLine (COL) is fully certified by NCQA* for 10 out of 10 services; vastly reducing the due diligence oversight requirements for MCO, MBHO, PPO and other healthcare organizations.
• COL follows the ten principles set forth by JC for CVO, providing you with confidence in the completeness, quality, and timeliness of the verification process.
• COL has an Operations/Credentialing staff with more than 100 years combined experience in credentials verification services.
• Application management, with choice of electronic or hard copy applications, for any healthcare organization.
• Cost effective solution for assisting healthcare organizations in meeting primary source verification and time limits established by organization bylaws, rules and regulations, and accrediting agencies such as JC and NCQA.

CredentialsOnLine: Frequently Asked Questions

1. What provider types do you process?

COL verifies credentials on physicians and non-physicians for MCO, MBHO, PPO and other healthcare organization such as hospitals, clinics and ambulatory/surgery centers.

2. What is your average turn-around time for completion of the verification process?

Turnaround time is generally controlled by the verifying entities’ responses, but by utilizing an automated fax program and various electronic verification sources, such as the NPDB, FSMB, AMA, ABMS, NTIS and multiple state licensing boards, COL’s average turnaround time for the verification process is well within the NCQA time requirements.

3. Who initiates the application process?

The health care organization determines who will initiate and manage the application process.

4. How does the healthcare organization track the status of its provider files?

COL provides a secure, comprehensive client website. The site provides a provider profile and multiple real time reports enabling authorized clients to check the progress of the data entry, data collection and verification processes. The profile and reports enable quick identification of incomplete applications, as well as delays and challenges in the verification process. COL also sends frequent email status messages to clients notifying them when an application is received, of any potential “red flag” verifications, and when an application is completed. All provider application and verification information is available for download by authorized clients.

5. Do you notify us of disciplinary or possible adverse information identified during the verification process?

Yes. COL credentialing specialists compare information submitted by the provider with responses from the verifying entity. Actions and/or possible adverse information such as license sanctions, malpractice judgments and settlements, adverse peer references or training records are marked with ‘red flags’ and the client notified by email upon discovery.

6. How does the healthcare organization receive the completed product? COL provides email notification to the healthcare organization upon completion of the verification process. Healthcare organizations can contract with COL to receive credentialing information electronically or in hard copy, by USPS.

7. We require additional elements to the NCQA standards, i.e., personal references and malpractice claims history can you also verify these for us?

Yes, we can tailor our process to meet your verification requirements.

8. We need to verify a backlog of applications immediately. Can we use your CVO on a temporary basis to complete these applications?

COL offers a wide variety of services to meet short-term or long-term credentials verification needs.

9. Can you assist us with monitoring of expiring credentials between reappointment cycles?

Absolutely, we offer management services for expiring credentials where we do the following:

• Monitor expiring credentials (license, DEA/CDS, malpractice insurance coverage and board certification) for all providers in client database
• Verify or data collect renewal information
• Create summary reports of expiring documents
• Communicate renewal to client

10. Does COL have a mechanism in place to monitor license and Medicare/Medicaid sanctions between reappointment cycles?

Yes. Medicare/Medicaid Sanctions/Exclusions: COL queries the List of Excluded Individuals/Entities (LEIE) from the Office of Inspector General (OIG) on a monthly basis and reports any sanctions and/or exclusions back to the healthcare organization upon discovery.

License Sanctions: COL also provides ongoing monitoring of license sanctions in the healthcare organization’s service area. Any loss or limitation of license, state sanctions, restrictions and/or limitations in scope of practice are reported back to the healthcare organization upon discovery.

11. We are putting together a proposal for outsourcing our credentialing and verification, what do you charge?

Our fee per provider file depends upon each client’s specific needs. We offer verification element profiles to comply with NCQA and JC standards. Each client may add or delete credentials elements to tailor a specific verification set. In addition to verification services, we offer application management, expiring credentials management and ongoing monitoring of license and/or Medicare/Medicaid sanctions services. Each client can select any or all of the additional services.

12. What are the average cost savings you can offer to a plan or provider group?

Costs can be reduced in many ways – staffing is certainly the greatest. Industry statistics indicate that the cost to process an application range from $200-$400, depending upon the information required. This includes staff time, computer expenses, postage, paper, filing and fees charged by various agencies.

For example, let us say that the average salary of the credentialing specialist was $35,000 and there were three employees handling credentialing and they had 500 physicians to recredential every year and 100 reappointments per year. The cost of COL processing these respectively is $50.00 for each recredentialing and $100.00 for each initial appointment fee. This sum is significantly lower than having the health plan or organization cover these costs.

Click here for a CredentialsOnLine cost analysis

COL also employs our advanced Internet based credentialing software, Echo. Echo technology allows us to streamline the credentialing process by using a variety of online sources and our proprietary databases. Through the use of Echo, processing time for credentialing is easily decreased by 10 to 14 days.

In addition to quick turn-around time for processing, providers or office staff can also streamline the application process through utilizing EchoApps. Providers fill out an initial assessment once, which is used to populate future applications electronically from our extensive application library. EchoApps also includes quality control to ensure that data is current, secure and complete.

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