Health Plan (7.4) 7.4

P-CR 9 - Primary Source Verification

Submited by: Tom Goddard

The Basics

Your organization must verify the "licensure or certification as minimally required to engage in clinical practice" and board certification (if applicable) or the highest level of education achieved by the practitioner, using primary sources. "Primary source verification" is defined as "verification based on information obtained directly from the issuing source of the credential."
In other words, for these two categories (licensure/certification and board certification or highest level of education), you must obtain verification (written, telephonic, or electronic) from the issuing source that the credential is valid and current. Most commonly, this involves going to a website maintained by the issuing body and printing off a page that verifies the credential. In the absence of that, a letter, or a documented phone call (including staff person making the call, date of call, and name of the person at the issuing entity with whom the staff person spoke) will suffice. Whichever approach you take, make sure that you are following your organization's policies and procedures regarding primary source verification during credentialing.

Management Tips

The key component for management is to make sure that the applicable policy and procedure or credentialing plan addresses the means by which you will use primary source verification processes. Whatever methods are chosen (website, letter, or telephone), it is essential that the documentation include sufficient information. For example, for licenses, you must verify not only its present validity, but the expiration date.
If the board certification is of the type that does not expire, it must be verified only upon initial credentialing. However, if there is a possibility of expiration of board certification, it must be reverified upon re-credentialing.
Make sure that your documentation includes an indication as to which member of the staff is doing the primary source verification. This is an essential part of the documentation for this standard.

Accreditation Tips

Desktop Review
It will be sufficient to provide the credentialing plan at the desktop review phase, so long as the credentialing plan is detailed in its description of the processes used for primary source verification.
Validation Review
The URAC reviewer will interview members of the credentialing staff and may even observe members of the staff as they conduct primary source verification.
Document Review
The URAC reviewer will examine 35-40 of your credentialing files to assure compliance with the standard.

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