1. Establishing and Understanding a CVO
Cheryl Cisneros, RN, BSN, CPCS, CPMSM
Client Success Manager and Consultant

2. Objectives What it takes to develop a CVO Services provided by a CVO
Define what is a Credentials Verification Organization (CVO), types of CVOs and history
What it takes to develop a CVO
Services provided by a CVO
Benefits of CVO NCQA Certification

3. What is a Credentials Verification Organization (CVO)?
A CVO is an organization which gathers data and verifies the credentials of health care practitioners. Typically it includes physicians, dentists, advanced practice nurses, physicians assistants, psychologists, and other practitioners who are members of a health care organization or health plan.
Provides credentialing services
Provides supportive services
Overcomes obstacles
Opportune efficiencies
Improves onboarding timeframes

4. What is the History of CVOs?
CVOs have evolved over time with a consistent focus to create streamlined workflow processes.
Over 30+ years ago medical societies centralized credentialing
As managed care organizations (health plans) increased, so did CVOs
Today CVOs support organizations to provide services which meet increased demands. How?
Developing Internal CVOs
Enterprise Credentialing

5. Credentialing and Payor Enrollment: What is the difference?
Credentialing is the process of obtaining, reviewing and verifying the documentation provided by a licensed professional for granting hospital membership and/or privileges or for payor enrollment.
Payor Enrollment is the process to request participation in a Commercial health insurance network, Medicare and/or Medicaid. It also includes when you add, change, term a practitioner or group office practice location. Confirmation is completed to insure timely and optimal reimbursement of submitted claims for services provided by practitioners to enrollees and patients.

6. Are there different types of CVOs?
Health Care Organization CVO
Regulatory Body Requirements
Organization Requirements
Not for Profit
Payer Delegation Requirements
Certified / Accredited
Independent CVO
Customer Requirements
For Profit
Contracted

7. What does it take to start a CVO?
Shared vision of the future state which includes a plan with goals, target dates and accountabilities.
Endorsement and Ongoing Collaborative Support:
Health System Leadership
Medical Staff Office Leaders
Health Plan, PHO, IPA
CVO Leaders
Staff

8. Developing a CVO
What do you
need to consider?

9. Initial Assessment – Value & Cost
What is the cost to credential a practitioner?
Baseline Metrics
Time to Credential
Volume Data
Practitioner Satisfaction
Develop Budget
Staff – work with human resources
Office Space
Software
Equipment

10. Documents - Collect, Review, Standardize
Request for Application
Applications (organization, state mandated, addendum)
Attestation / Release of Information
Privileges
Bylaws, Rules and Regulations, Credentialing Plan
Application & Reappointment Packets
Practitioner Enrollment Packet
Payer Applications
Policy and Procedures, etc.

11. Credentialing Process Review - Tasks, Timeframe, Accountability
Application Request
Send Application & Privileges
Application & Privilege Review
Verification
Approval Process
Handoffs
Communication
Update Database(s)

12. What Services are Provided by a CVO?

13. Process Applications Initial Application Recredentialing Locum Tenens
Request for Additional Privileges
Privileges
Case Logs
NPDB CQ Enrollment
Criminal Background Check

14. Primary Source Verifications
Education and Training
Medical School
Residency/ Internship
Graduate Education
Fellowship
Licensure
DEA , Controlled Substance
Work History
Malpractice and Sanction History
Board Certification

15. Ongoing Monitoring Professional Licensure
Office of Inspector General (OIG)
Medicare / Medicaid Sanction List
Medicare Opt Out
Social Security Master Death File

16. Expirables Professional License DEA
Controlled Substance (as required by state)
Insurance
Board Certification

17. Quality Audit(s) Database Maintenance
Initial and Locum - Verifications and Database
Reappointment - Verifications and Database
Database Maintenance
Offices
University(s)
Graduate Educational Programs
Hospitals
Board Certification
Etc.

18. Other Services Reports Expirables Payer rosters
AdHoc – i.e. Business Development, Marketing
Metrics
Application Verification TAT
Onboarding TAT
Total Applications Completed
Health Information – i.e. Flu, Immunization Compliance

19. Benefits - CVO NCQA Certification
Recognized by Commercial Health Plans
Health Plan Credentialing Delegation Agreements
Reduce burden of organization’s need to submit payer credentialing applications for employed practitioners
Improved onboarding timeframes
Decreased onboarding timeframe
impacts your Organization’s
Bottom Line!

22. Cheryl Cisneros, RN, BSN, CPMSM, CPCS
Client Success Manager and Consultant
Morrisey, A HealthStream Company