What is Primary Source Verification?

Primary source verification is an essential step in provider credentialing for new hires before a hospital grants privileges, and done on a regular basis to ensure that an existing provider’s qualifications are valid and current.

Provider credentialing ensures patient safety, and that the quality of patient care meets certain standards. It also protects the hospital from liability and corporate negligence by enforcing compliance with regulatory/accrediting agencies such as The Joint Commission, NCQA, HFAP, and AAAHC. By checking that a provider’s qualifications are valid and current, healthcare organizations help ensure quality patient care.

Primary Source Verification (PSV) is required for confirming that an individual possesses a valid license, certification or registration to practice a profession when required by law or regulation.

The glossary of The Joint Commission Accreditation Manual defines PSV as:

According to the Joint Commission, “primary source verification (PSV) is required for confirming that an individual possesses a valid license, certification or registration to practice a profession when required by law or regulation. It is the responsibility of the accredited organization to complete PSV, not the licensed individual.”

Completing primary source verifications during the credentialing process will protect both the patient and the provider. It is the responsibility of the accredited organization to complete PSV, not the licensed individual.

When onboarding a new provider or performing routine credentialing, the government expects healthcare organizations to verify that all providers have the valid and current licenses required for their professions.

Primary source verification is vital to accurate and credible credentialing. It is simply inadequate to accept information submitted by a provider or document photocopies at face value.

PSV protects your patients’ safety by helping to ensure your practitioners are qualified to care for them. Furthermore, it protects your organization from legal risks and compliance issues.

If an organization fails to verify its providers’ credentials through a primary source, they risk gathering inaccurate, biased, or incorrect information from other sources. Primary source verification and documentation protect patients by ensuring that providers are qualified and competent to practice and that their license is in good standing.

Without primary source verification, healthcare organizations may unknowingly risk patient safety.

Whenever possible, organizations should obtain information from a primary source through direct correspondence, telephone calls, electronic verification, or credentials verification organization (CVO) reports.

A primary source is the original body, organization, or person who issued the information under review. These sources would have direct knowledge of the validity of information stated by the practitioner, which means verification is received directly from the issuing source.

Primary sources include the following: government agencies, educational institutions, former employers, and professional associations.

• Medical schools
• Residency programs
• ECFMG (Education Commission for Foreign Medical Graduates)

• Hospitals
• Medical staff offices
• Professional/peer references

• Background checks
• Criminal history
• Military Personnel Record
• State Licensing Boards
• Federation of State Medical Boards
• Medicare and Medicaid Sanctions
• National Practitioner Data Bank (NPDB)
• State Certifications
• List of Excluded Individuals/Entities

• Affiliations (e.g. American Medical Association)
• Professional certifications

Where primary source verification is not possible, secondary sources are the next best option. This may occur in situations where primary source data is not available, such as a medical school or hospital that has closed. In these situations, organizations should do all they can to obtain the data, including checking with successor organizations, determining if original documents were sent elsewhere, or contacting other hospitals or schools in the area for information.

A primary source may designate another organization as its agent for the purpose of providing information to verify credentials. This other organization is then considered a DES, which permits them to serve as the primary source during the verification process.

The Joint Commission defines a Designated Equivalent Source (DES) as “selected agencies that have been determined to maintain a specific item(s) of credential(s) information that is identical to the information at the primary source.”

• The American Medical Association (AMA) Physician Masterfile for verification of a physician’s U.S. and Puerto Rican medical school graduation and postgraduate education completion; this database contains provider data which has been obtained directly from the primary sources
• The American Board of Medical Specialties (ABMS) for verification of a physician’s board certification
  The Educational Commission for Foreign Medical Graduates (ECFMG) for verification of a physician’s graduation from a foreign medical school
• The American Osteopathic Association (AOA) Physician Database for pre-doctoral education accredited by the AOA Bureau of Professional Education, post-doctoral education approved by the AOA Council on Postdoctoral Training, and Osteopathic Specialty Board Certification
• The American Academy of Physician Assistants (AAPA) Profile for physician assistant education, provided through the AMA Physician Profile Service
• The Federation of State Medical Boards (FSMB) Disciplinary Action Databank for all actions against a physician’s medical license

Although Primary Source Verification is a very involved and time-consuming process that entails manual, repetitive tasks, it must be completed for EACH credential and for EVERY provider.

Even if there are limited in-house resources to complete the complex, time-consuming process of primary source verifications, healthcare organizations MUST prioritize this process to protect patients and ensure compliance.

Fortunately CredentialPro can assist with streamlining this process by contacting each of these sources on your behalf and documenting the completion of PSV for your providers’.

Our Primary Source Verification specialists can save you time and resources, allowing you to focus your staff and providing optimal patient care while minimizing risk to your organization.

For more information on primary source verification and how CredentialPro can help, contact us today.