Primary Source Verification

The process of verifying a provider's credentials directly from the original issuing source, such as medical schools, licensing boards, and certification bodies, rather than relying on copies or secondary reports.

Primary source verification, or PSV, is the process of confirming a provider's credentials directly with the issuing organization rather than relying on copies of documents submitted by the provider. This is a non-negotiable requirement for every credentialing process. When a payer credentials you, they do not simply look at the copy of your medical license and accept it at face value. They contact the state licensing board directly to confirm your license number, issue date, expiration date, and whether there have been any disciplinary actions. They contact the National Practitioner Data Bank to check for malpractice payments and adverse actions. They verify your board certification with the relevant specialty board. NCQA requires primary source verification for the following: medical or professional school graduation, residency and fellowship training completion, current state licensure, board certification status, DEA registration, malpractice claims history through the NPDB, and any sanctions or exclusions through the OIG. The reason this exists is straightforward. In the past, some providers falsified their credentials. There were cases of people practicing medicine with forged diplomas or revoked licenses. Primary source verification catches these situations. It protects patients and protects the payer from liability. As a provider going through credentialing, PSV is happening behind the scenes. You do not need to do anything special beyond making sure all your information is accurate and up to date. But you should know that if any of your credentials cannot be verified, the process stops. An expired license, a lapsed board certification, or a discrepancy between what you reported and what the primary source says will delay your application until the issue is resolved.