Credentialing and Re-Credentialing

The process through which an organization (e.g., a hospital, insurance network, clinical practice, or physician group) decides whether a candidate is qualified to render acceptable quality of care to patients. Credentialing focuses on the collection and verification of information.

Over 20 years, VerifPoint has been providing full Credentialing and Re-Credentialing services as well as Primary Source Verification.

Credentialing Standards

Our team of experts know how to credential a physician keeping the standards of NCQA (The National Committee for Quality Assurance), URAC (Utilization Review Accreditation Commission), AAAHC (Accreditation Association for Ambulatory Health Care), CMS (The Centers for Medicare/Medicaid Services), ICE (The Institute for Credentialing Excellence) and JC (The Joint Commission) in mind.

NCQA Credentialing:

  • License to Practice.
  • DEA or CDS Certification.
  • Education and Training.
  • Board Certification Status
  • Work History.
  • Malpractice Claims History.
  • State Licensing Board Sanctions.
  • Medicare/Medicaid Sanctions.
  • Practitioner Application Processing.
  • Application and Attestation Content.
  • Ongoing Monitoring of Sanctions.

URAC Credentialing:

  • License to Practice. (All States where Provider is practicing)
  • DEA or CDS Certification.
  • Education and Training.
  • Board Certification Status
  • Work History.
  • Malpractice Claims History.
  • State Licensing Board Sanctions.
  • Medicare/Medicaid Sanctions.
  • Practitioner Application Processing.
  • Application and Attestation Content.
  • Ongoing Monitoring of Sanctions.

CMS Credentialing:

  • License to Practice.
  • DEA or CDS Certification.
  • Education and Training.
  • Board Certification Status
  • Work History.
  • Malpractice Claims History.
  • State Licensing Board Sanctions.
  • Medicare/Medicaid Sanctions.
  • Practitioner Application Processing.
  • Application and Attestation Content.
  • Ongoing Monitoring of Sanctions.
  • CMS Opt-Out
  • SAM (EPLS)
  • State OIG

The JC Credentialing:

  • License to Practice. (All States – Current and Past)
  • ECFMG
  • DEA or CDS Certification.
  • Education and Training.
  • Hospital Affiliations (Current and Past)
  • Peer References
  • Board Certification Status
  • Malpractice Claims History.
  • State Licensing Board Sanctions.
  • Medicare/Medicaid Sanctions.
  • Practitioner Application Processing.
  • Application and Attestation Content.
  • Ongoing Monitoring of Sanctions.
  • CME
  • Delineation of Privileges (DOP)

AAAHC Credentialing:

  • License to Practice. (Current License)
  • DEA
  • Education and Training.
  • Board Certification Status
  • Work History.
  • Primary Hospital
  • Peer References
  • Malpractice Claims History.
  • State Licensing Board Sanctions.
  • Medicare/Medicaid Sanctions.
  • Practitioner Application Processing.
  • Application and Attestation Content.
  • Ongoing Monitoring of Sanctions.
  • Delineation of Privileges (DOP)

VerifPoint Benefits

The benefits our credential verification service offers include:

Online provider applications – we can populate physician data from our online form into any privileging or credentialing application form

Virtually paperless, weekly reporting system using state-of-the-art technology

Special Urgent service for providers who need to be credentialed as soon as possible through our “Rush Credential Service”

The security of knowing your data is stored confidentially and safely on our servers

Freedom from bearing the hassles of follow up on expired medical licenses, DEA certificates, and other time-sensitive documents

Regularly update provider directories and network reports so that you can get the information you need to manage your provider network efficiently

Immediate reporting when a provider has sanctions or adverse actions against their license

Notification of when new physicians join a practice without informing you, inherently building your network size

VerifPoint Reports

VerifPoint’s reports contain information such as the following:

  • State License(s) & Drug Certificates (DEA, SDC, TPA, etc…)
  • Education and Training / Board Certification
  • Works, Malpractice Insurance & Claims History
  • Medicare/Medicaid Sanctions & Ongoing Monitoring of Sanctions
  • NPDB/HIPDB Report
  • Attestation Content & Reference Verification
  • Practice Locations & Unique Identifiers

What type of Provider can VerifPoint Credential?

VerifPoint credentials all practitioner types including but not limited to:

  • AUD (Doctor of Audiology)
  • CRNA (Certified Registered Nurse Anesthetists)
  • DC (Doctor of Chiropractic)
  • DDS/DMD (Doctor of Dental Surgery / Doctor of Medicine in Dentistry)
  • DO (Doctor of Osteopathic Medicine)
  • DPM (Doctor of Pediatric Medicine)
  • EdD (Doctor of Education)
  • LBSW (The Licensed Baccalaureate Social Worker)
  • LCDC (Licensed Chemical Dependency Counselors)
  • LCSW (Licensed Certified Social Work-Clinical)
  • LDO (Licensed Dispensing Optician)
  • LMFT (Licensed Marriage and Family Therapist)
  • LMSW (Licensed Master Social Worker)
  • LMSW-AP (Licensed Master Social Worker – Advance Practitioner)
  • LPCC (Licensed Professional Clinical Counselor)
  • MD (Doctor of Medicine)
  • NP (Nurse Practitioners)
  • OD (Doctor of Optometry)
  • OPT (Ophthalmic Therapist)
  • OT (Occupational Therapist)
  • PA (Physician Assistant)
  • PhD / PsyD (Doctor of Philosophy / Psychology)
  • PT (Physical Therapist)
  • PTA (Physical Therapy Assistant)
  • RDH (Registered Dental Hygienist)
  • RDO (Registered Dispensing Optician)
  • RN (Registered Nurse)
  • SLP (Speech Language Pathology)