EPCMS Centralized Credential Verification Service

Several recent articles in professional magazines state what we've known in our community for a long time, "the credentialing process can be an exercise in frustration, both for the physician and the institution involved."

Our service began as a cooperative effort between the society and local hospitals developed for the benefit of physicians and the community, and is now a fully computerized system for gathering and distributing complete, up-to-date professional credential verifications through a single source. We collect written verification, from the primary source, of all professional activity beginning with medical school to the present date. The following will give you details about how the service operates:

What is the El Paso County Medical Society Centralized Credential Verification Service (CCVS)

Centralized Verification is a process by which one central agency provides VERIFICATION of practitioners credentials to numerous health care organizations with credentialing responsibilities including health maintenance organizations, individual practice associations, hospitals, preferred provider organizations, exclusive provider organizations, medical groups, rehabilitation and ambulatory surgery centers.

Centralized verification is a recommendation of the American Medical Association's Hospital Medical Staff Services Section Governing Council and recognized by the Joint Commission on Accreditation of Health Care Organizations (JCAHO) as an outside agency to collect information on behalf of a health care facility.

With a medical society program a practitioner has to complete only one application form for any number of organizations with credentialing responsibilities. We use a joint application form for organizations that subscribe. Using a standardized form makes completing, processing and reviewing applications easier. A standard form for credential verifications is designed by taking into consideration the importance of compliance with laws such as the Americans With Disabilities Act. This form is reviewed and updated regularly.

Why Centralized Verification Makes Sense

In recent years, the great emphasis placed on providing quality patient care has increased the responsibility of all health care providers. The practitioner appointment or credentialing process currently requires an exhaustive task of gathering and verifying all background data and reference information on an applicant in order to assure that privileges are granted only to qualified individuals. Hospital medical staff professionals are overworked. They have to find ways to work smarter, quicker and more efficient.

Most physicians apply for membership to several health care facilities and organizations so that the credentialing process is duplicated a number of times. CCVS assists providers and organizations with the complex, detailed and time consuming aspects of the primary source verification of physician and other provider credentials. Results of a recent survey estimated that a health care entity spends $400.50 to process and initial appointment. On average, we execute about 21 letters (usually more) for each applicant during the appointment process. When you multiply that figure by three to five facilities, it is easy to see how a centralized service can save both money and time.

A solution to this "paper chase" is our medical society centralized verification service that offers a single source for the comprehensive, uniform, state-of-the-art verification and distribution of an applicant's background information for initial application, reappointment and recredentialing.

Though medical society programs vary in the services provided and the process used, Centralized Verification Collection Services are usually organized in such a way that an applicant provides the background information to the service, the credentialing service completes the verification process and provides the information to its contracted organizations.

All information verified by CCVS is strictly confidential and released only with prior permission by the physician or health care provider being credentialed. Both the practitioner and the facility must authorize the verification process before the credentialing information is processed and distributed. Credentialing Services exist only to verify and provide copies of the documentation it receives. CCVS does not make credentialing decisions for organizations, but it does make the process easier by doing the detailed paperwork required for such decisions. Health care facilities still maintain the decision-making authority to grant or deny privileges.

All parties involved in the service benefit. Medical Societies enhance services for its members and promote the image of the organization as an important link between the practitioner and the health organizations. Facilities streamline and improve their credentialing process while saving time and money spent verifying the information, allowing their valuable staff services personnel to perform other essential duties.

Practitioners also benefit from the centralized approach. Because one standard application is used for all facilities the applicant's office only receives one phone call or letter for information, rather than multiple requests. Reducing duplication and streamlining the appointment process creates a WIN, WIN, WIN situation for the practitioner, the health care facility and the medical society.

An article in a recent Overview publication quoted a hospital credentials specialist as saying, "During the last two years, the medical society has processed 111 applications for my hospital. This is the equivalent of hiring an employee who never takes a vacation, never calls in sick, does exactly what he's told without question, and produces outstanding results every time! Signing that contract with the medical society for centralized credentialing was, in my view, hiring the best assistant I've ever had."

General Centralized Credential Verification Service Process

1. A practitioner is furnished a list of the Service's participating facilities with information on each facility's standards, along with the Service's application form.

2. After the practitioner selects the facilities they wish to apply to, the Service furnishes the facility with a copy of the Application Request Form which includes details on qualifications and asks the facility if it will accept an application.

3. Facilities notify the Service to proceed if the practitioner meets their initial standards for application.

4. The practitioner completes one standard application form that has been approved by the participating facility and specific privilege forms for each facility where the practitioner is seeking membership.

5. After the Service receives the completed application, the information is entered into a computerized database. Using a centralized credentialing software program, verification letters are generated to meet Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and National Committee for Quality Assurance (NCQA) requirements, including:

Medical Education/Fifth Pathway Licensure

Board Certification

Professional Liability Coverage

Practice History

Academic Appointments

AMA Profile

ECFMG

Internships/Residencies

DEA Registration

Health Care Affiliations

Military Experience

Professional References

Department Chairs

6. The requests are tracked in the system to provide the practitioner and facility with an update on a regular basis.

7. As verification information is returned and processed, copies are forwarded to the facility where the practitioner has applied for membership. (Each facility receives authenticated copies to fulfill JCAHO standards). Each facility then begins their standard credentialing process of committee review before membership is granted.

Other Benefits Which Can Be Provided To Participating Facilities

The Service is able to assist participating health care facilities in their reappointment process, providing current demographic practitioner profiles along with copies of medical licenses, DEA's, BNDD's, professional liability insurance certificates and National Practitioner Data Bank querying reports.

Additional services could include:

1. Comprehensive Demographic Practitioner Database.

2. Practitioner Profiles.

3. Ongoing Verification of state license, DEA, BNDD, professional liability insurance and querying information from the National Practitioner Data Bank.

4. Computer Services such as rosters, reports and labels.

Legal Implications Of Centralized Credentialing

One of the most frequently asked questions about implementing a centralized credentialing service is, "What are the legal implications of sponsoring or participating in a centralized credentialing collection service?"

The Joint Commission on Accreditation of Health Care Organizations (JCAHO) currently requires that "the granting of delineated clinical privileges is based on verified information regarding the applicant's licensure, specific training, experience and current competence." (MS.4.2.5. Accreditation Manual for Hospitals, p.111 (1989).

This requirement has been interpreted by the Joint Commission as permitting an outside agency (i.e. medical society) to collect information on behalf of a health care facility, as long as the outside agency sends copies of the actual documents collected directly to the hospital, and the hospital verifies the credentials (Joint Commission Perspectives, p.5, Sept./Oct. 1987).

This JCAHO interpretation focuses on the heart of the issue. A medical society centralized credential verification service acts only as the information collection mechanism; facilities retain all decision-making authority required to fulfill their legal and statutory obligations pertaining to granting of clinical privileges, medical staff membership and membership.

When implementing the service, medical societies develop policies and procedures on the data collection process. These policies and procedures consider both Federal and State medical law. Confidentiality and procedure policies are created on what data will be collected and how it is to be distributed as a vital step in fulfilling legal requirements. Additionally, each participating facility needs to reflect the use of an outside collection agency in its bylaws and credentialing procedures.

By determining in advance which policies are necessary and reviewing state regulations, centralized credentialing collection services can minimize legal implications while assisting facilities in fulfilling their credentialing requirements.

Credibility and Demonstrated Expertise:

The EPCMS Centralized Credential Verification Service was established over 20 years ago. Our staff is well qualified and experienced in this process.

Our Executive Vice President, Carol Walker, is a respected leader of the National Credentialing Forum. Medical societies who serve as credentials verification organizations (CVOs) are now able to share information, participate in educational meetings and look at the development of national credentialing standards. NCF members are involved in local, state and national organizations and participate in educational and leadership opportunities available through those professional associations.

This group includes representation from the majority of medical societies in the United States who provide credentialing services and the American Medical Association. They are up-to-date on regulations and accrediting requirements through organizations such as the Joint Commission on the Accreditation of Health Care Organizations (JCAHO), and the National Committee for Quality Assurance (NCQA).

Aimee Woolley, the EPCMS CCVS Membership Coordinator, works with applicants and facilities to see that the process operates efficiently. Aimee is able to make a very tedious process run smoothly with the least possible frustration. The benefits of her skills are appreciated by all those involved.  For more information regarding the credentialing process, or to request an application packet, contact Aimee at 591-8723 or aimee@epcms.org