CVO

A Credentials Verification Organization is a third-party entity that performs primary source verification of provider credentials on behalf of health plans, hospitals, or other healthcare organizations.

A Credentials Verification Organization is a third-party company that handles the primary source verification process on behalf of health plans. Instead of every payer running their own verification department, they outsource the grunt work to a CVO. The CVO contacts medical schools, state licensing boards, certifying boards, the NPDB, the OIG, and every other source needed to verify your credentials. They compile a report and hand it to the payer's credentialing committee for the final decision. The CVO does not make the approval decision itself. That stays with the payer. Why does this matter to you as a provider? Because if your credentialing application seems to be sitting in limbo, the CVO is often where the bottleneck lives. The payer might tell you your application is "in process," but what that really means is the CVO is still trying to verify one of your credentials and hit a dead end. Maybe your medical school is slow to respond. Maybe your old state license from 12 years ago has a note on it that needs clarification. NCQA certifies CVOs through a rigorous accreditation process. If a payer uses an NCQA-certified CVO, the verification is considered to meet NCQA standards, which means the payer does not need to re-verify the same information. This speeds things up significantly when you are applying to multiple payers that use the same CVO. Some of the largest CVOs in the country include Verisma, VerityStream, and Medallion. If you are going through credentialing and want to know where your application stands, 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 provider services line.