Credentialing Verification Organization

A third-party entity that performs primary source verification of healthcare provider credentials on behalf of health plans, hospitals, and other organizations.

A Credentialing Verification Organization, or CVO, is a company that handles the legwork of verifying provider credentials on behalf of health plans, hospitals, and other organizations. Instead of every payer running their own verification department, they outsource the process to a CVO that specializes in contacting primary sources and compiling verification reports. The CVO contacts medical schools, state licensing boards, specialty certification boards, the NPDB, the OIG exclusion list, and every other source required to verify your credentials. They compile everything into a standardized report and deliver it to the payer or hospital that hired them. The CVO does not make the credentialing decision. That stays with the payer or hospital credentialing committee. Major CVOs include VerityStream, symplr, Medallion, and several others. Many are NCQA-certified, which means their verification process meets national quality standards. When a payer uses an NCQA-certified CVO, the verification results are accepted by other NCQA-accredited organizations without needing to repeat the process. From your perspective as a provider, you rarely interact directly with a CVO. They work behind the scenes. But if your credentialing application is stuck, the CVO is often where the delay lives. The payer tells you it is in process, but what that actually means is the CVO cannot verify one of your credentials. Maybe your medical school is slow to respond. Maybe there is a discrepancy between what you reported and what the licensing board shows. If you suspect a CVO-related delay, ask the payer which CVO they use. Sometimes you can contact the CVO directly to resolve verification issues faster than going through the payer's general provider services line.