Managed care organizations like health management organizations (HMO) and independent provider associations (IPA) are required to credential their providers, meaning they have to verify the medical providers professional history. Because of the dispersed nature of managed care organizations and the resource requirements of the credentialing process, credentialing verification organizations (CVO) step in to provide these credentialing services.
Overview of Credentialing
The two major accrediting organizations for managed care organizations are the National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Council (URAC) As part of their accreditation requirements, both URAC and NCQA require managed care organizations to credential their providers according to their published standards.
While it is less common for preferred provider organizations (PPO) to credential their practitioners, credentialing lowers risk and liability, while improving patient care. As an example of how important these standards can be for PPO quality, more than 10% of the organizations certified by NCQA are PPOs.
Credentialing verification...
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