| Quality credentialing verification organizations | | | | copy of their quality control policies and practices |
| (CVO's) create an environment beyond simply | | | | documentation. If they are accredited by NCQA |
| generating credentialing reports for medical | | | | or URAC, then there is a guarantee that these |
| providers. A CVO with good customer service | | | | practices have been reviewed and audited and |
| responds quickly to questions; has trained staff | | | | that their service meets industry standards.High |
| that is assigned to a particular client; can | | | | quality services. |
| streamline the credentialing process; has good | | | | Two attributes of quality work are timeliness and |
| technology resources; and offers extra support, | | | | thoroughness. Good CVOs will return credentialing |
| such as internal audits and tracking license | | | | reports as quick as industry norms, meaning |
| renewals. An emphasis on customer service | | | | around 60 days for hospital standards (JCAHO) |
| means that the CVO can supply substantive | | | | and 30 days for managed care standards (NCQA |
| information and support to establish a true | | | | and URAC). The credentialing reports will also be |
| working relationship with a medical | | | | complete - no missing data or criteria and with full |
| organization.There are five areas of a CVO's | | | | supporting documentation. CVOs should have an |
| customer service to consider: flexible credentialing | | | | established maximum number of requests they |
| processes which can be adapted in response to | | | | make to organizations for information and other |
| client needs; a range of quality services; quick | | | | avenues of finding information. Problem files should |
| responses to clients; individual support; and solid | | | | be brought immediately to the review |
| technology practices. Although some service | | | | committee's attention. All of these practices work |
| points, such as a fast response to questions, can | | | | together to make a thorough credentialing |
| seem small, these areas display the quality of the | | | | report.Additionally, good CVOs offer services such |
| CVO, which will define the long-term relationship | | | | as tracking licensing dates and requirements |
| between the CVO and its clients.Adapting | | | | (expirables) and disciplinary actions by various |
| credentialing services to client needs. | | | | organizations (surveillance); consulting and training |
| CVOs should be responsive to their clients' needs. | | | | classes about credentialing processes; and support |
| The CVO should be accredited by either | | | | during internal audits.Quick response to client |
| accrediting organization: National Committee for | | | | contact. |
| Quality Assurance (NCQA) or the Utilization | | | | Good CVOs respond to questions within 24 |
| Review Accreditation Councile (URAC) or comply | | | | hours. They should answer any questions fully and |
| with their credentialing standards. In addition, the | | | | as quickly and directly as possible rather than |
| CVO should add new credentialing standards for | | | | postponing or transferring them.Technology |
| their clients and should also be able to adapt their | | | | resources. |
| credentialing processes by adding special criteria or | | | | CVOs should be using the most recent |
| using a subset of criteria. This flexibility includes | | | | technology, such as databases, paperless |
| making recommendations to streamline processes | | | | credentialing, and web access with adequate |
| and working with clients to determine what they | | | | security and access control.Customer service is |
| need rather than following a preset | | | | key to creating a good relationship between |
| checklist.Individualized support and quality controls. | | | | CVOs and medical organizations. Quality control |
| Individualized service means that there is a | | | | policies, flexible credentialing processes and criteria, |
| dedicated representative for each client. There | | | | quick response time, good technology use, and |
| should be a known manager to handle difficult | | | | responsiveness to questions and requests are five |
| situations and an established route to lodge | | | | major areas where a CVO develops good |
| complaints. All personnel should be trained to | | | | customer relations. All these areas mean the CVO |
| perform credentialing reports according to the | | | | is responsive - that the CVO is paying attention |
| accrediting organization's standards.There should | | | | to individual customer needs and consistently |
| also be an established quality control system and | | | | doing its best to meet them.Physician Credentialing |
| regular internal audits for managing feedback, | | | | Solutions is a leading provider of credentialing |
| rewarding good service, and evaluating bad | | | | verification services for hospitals, PPOs and other |
| practice. The CVO should be able to supply a | | | | health care organizations. |