Primary source verification is the process of confirming the facts of a doctor’s credentials from the source. For instance, you would confirm that a doctor has received a medical degree. Rather than relying on copies or reports from secondary sources, PSV seeks confirmation directly from the original or primary entity that issued the certification, degree, or license. This direct technique avoids the possibility of fraudulent claims and confirms that credentials are valid and have not been revoked or suspended.

Purpose of Primary Source Verification

Primary source verification is important for a number of reasons and provides numerous benefits for both hospitals and patients. This process is critical because it serves as a safeguard against the employment of unqualified personnel and helps prevent risk for hospitals and medical facilities. Beyond patient safety, PSV is instrumental in:

• Ensuring competence
• Maintaining compliance with regulatory bodies such as The Joint Commission, Centers for Medicare & Medicaid Services, and National Committee for Quality Assurance
• Mitigating risks from fraudulent doctors as well as botched care from unqualified professionals
• Providing trust between patients and the medical industries.
• Ensuring documentation of doctors and establishing criteria for skillsets and specialization
• Reinforcing policies of credentialing

When information may be easily created or distorted, primary source verification serves as a major barrier to the entry of unqualified individuals into the medical field. 

Common Criteria that Need to be Verified

The legitimacy of professional healthcare is dependent on the thorough verification of a practitioner’s credentials. Primary source verification (PSV) comprises a wide range of criteria, each of which contributes significantly to a professional’s qualifications. Common criteria for primary source verification can include, but is not limited to:

• Medical License
• Medical School Diploma
• Board Certifications
• Residency/Internship Training
• Work History
• Malpractice Claims
• Hospital Affiliations
• DEA Certificate
• Criminal History
• Professional References
• Proof of Insurance
• Ability to Perform

Who Does the Primary Source Verification?

You may be wondering “Who does all this verification?” Depending on the organizational structure, resources, and field-specific requirements, different entities may be in charge of doing primary source verification. Typically, this activity is completed by in-house verification teams or outsourced to third-party services. They both have their pros and cons. Let’s break it down.

In-house Verification Teams

Many hospitals and clinics prefer to manage primary source verification through dedicated in-house teams. These teams are usually part of the human resources department or a specialist credentialing department inside an enterprise. Staff can monitor the process and direct oversight of the credentialing process.

Pros:

• Having an in-house staff provides better control over the verification process, ensuring that it adheres to the organization’s specific requirements and schedules.
  
  
• In-house teams can ensure consistency across all verification processes using the same methods across candidates.
   
• Restrict access to internal documents and make sure the verification process is confidential.

Cons:

• Maintaining an in-house team necessitates significant resources, including employee training and access to verification databases and tools.
  
  
• It can be harder to scale your verification teams because you have to hire, train, and maintain staff levels to be fully operational.

Third-Party Verification Services

The other most common option is to use a third-party source, also known as outsourcing credentialing. These organizations specialize in credential verification and have the resources, databases, and networks in place to rapidly execute verifications across states and nations. These businesses focus solely on this objective.

Pros:

• Third-party services can frequently conduct verifications faster due to their specialized focus and resources.
  
• These teams at these organizations specialize in handling the complexity of foreign verifications and dealing with a variety of credentialing agencies. There can be a whole department dedicated to these types of cases.
  
• Outsourcing allows a medical organization to scale its credentialing capabilities without having to invest or train new staff. This saves time and allows organizations to move quickly to hire someone.

Cons:

• Less oversight than having everything in-house. You are essentially relying on someone to make sure the credentials are legit.

• The cost can be higher than simply hiring new employees. Again though, outsourcing allows you to scale much faster.

• There can be variability in the quality if you do not choose a highly qualified and reputable buyer.

The decision to use an in-house verification team or a third-party service usually depends on factors such as cost, control, knowledge, and the organization’s needs. Those with regular verification needs may find it more cost-effective and efficient to establish in-house teams, whereas smaller companies or those with intermittent needs may benefit from third-party solutions due to their flexibility and scalability.

How to Complete Primary Source Verification+

Primary source verification is a laborious process that necessitates a methodical strategy to assure the accuracy, compliance, and integrity of the credentials under review.  There are two main ways of achieving this process.

Direct Contact Verification

Direct contact verification entails contacting the issuing sources of credentials, licenses, and certifications to ensure the authenticity and current status of each document or claim. This method is regarded as the gold standard for primary source verification due to its directness and dependability.

Digital Verification

Digital verification uses internet databases, verification services, and digital platforms to speed up the verification process. While not all credentials can be digitally verified, this method can make the process proceed much quicker.

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