Credentials Verification Organization Certification Requirements

FOCUS AREAS TO ENSURE HIGH QUALITY

NCQA CVO Certification is designed to ensure that organizations can maintain a high-quality network for members and contracted clients. Requirements cover these key areas:

• An internal QI process.
• Protecting credentialing information.
• Verifying credentials.

To see all program requirements, get the Standards & Guidelines document.

REQUIRED ORGANIZATION SERVICES

The standards are designed for organizations that focus on credentials verification services, including verification of practitioner credentials through a primary source, through a recognized source or through a contracted agent of the primary source.

IS MY ORGANIZATION ELIGIBILE?

Any organization that provides credentials verification services can apply for Certification if it:

• Verifies practitioner credentials for health plans, MBHOs, physician organizations or health care organizations, and
• Provides verification services for at least six months before application, and
• Performs verification activities for at least 50% of contracted practitioners, and
• Maintains the necessary credentials documentation, policies and procedures for NCQA to conduct the survey, and
• Obtains errors and omissions insurance for $1M–$2M.