How To Choose The ‘Right’ CVO For Your Company
What to look for and red flags to avoid when vetting a CVO
Credentialing is a necessary and vital process for healthcare facilities — it ensures your medical providers are compliant, competent and legally able to perform certain services. However, most in the industry would agree that it can be a time-consuming and tedious practice.
For this reason, many companies find themselves overwhelmed and look to a Credentialing Verification Organization (CVO) for assistance. Similar to shopping for a new car, it’s important you know what you’re looking for and how you’d like it to perform. CVOs are incredibly advantageous, but they’re not created equally. We’ll dive into what to look for and red flags to avoid so you make the right pick for your business.
What is a CVO?
If you already know what a CVO is, you can skip to the next section. But if not, we’ll give a brief overview here.
A CVO helps healthcare companies with their provider licensing verification process so they can enroll in payers’ health plans and be reimbursed for services. CVO credentialing allows healthcare companies to offload this time consuming, yet essential, process, which may reduce administrative waste.
How do you select the right CVO for your business?
There are certain factors you should consider when searching for a CVO. After all, they’ll be an important partner and contributor to your business’s success. Here are six things to look for to help you select a CVO.
1. NCQA accreditation/certification
The National Committee for Quality Assurance (NCQA) is a non-profit focused on improving healthcare quality through evidence-based standards and programs. They’re seen as the industry’s gold standard, and achieving NCQA accreditation and/or certification demonstrates a company’s commitment to enhancing patient quality of care.
NCQA actually has two credentialing programs: Credentialing Accreditation and CVO Certification.
Credentialing Accreditation:
This is for those providing full-scope credentialing services, including verification and re-credentialing, credentialing committee review and monitoring practitioner sanctions.
CVO Certification:
Certification mainly focuses on verifying a practitioner’s credentials through a primary source and then reporting it back to their client.
For a CVO to achieve either NCQA designation means that they’ve undergone an extensive 12-month or longer evaluation/audit process.
If your company works with an NCQA-accredited or certified organization, you’ll also receive automatic credit on your NCQA survey. In addition, you’ll have peace of mind knowing they are a reputable and officially recognized CVO.
Lastly, NCQA-accredited organizations are better positioned to receive a delegation agreement with a health plan quicker, meaning that its providers will get enrolled faster.
Red flag: Companies without an NCQA CVO certification or Credentialing accreditation.
2. Their communication style
One fear that many people have when outsourcing credentialing is poor communication. Will the CVO respond promptly to inquiries and provide status updates throughout the verification process? They should!
Outsourcing shouldn’t mean that you’re in the dark about your concerns. The best CVOs are great communicators and will notify you of any disruptions in the process.
During the vetting process, it’s a good idea to look at testimonials and reviews associated with the CVO. It’ll help you get an idea of what others have experienced and give you an opportunity to address them in any preliminary conversations.
Red flag: The CVO has a lack of responsiveness to your needs, which could interfere with the quality and efficiency of the credentialing process.
3. Credentialing turnaround time
If you’re doing credentialing in-house, the process can take months. Even if the provider submitted all of their documents in a timely fashion, there are usually one or two errors that need to be remedied.
However, good CVOs shouldn’t have long, drawn-out credentialing turnaround times. They should have established relationships with payers and follow a set workflow that ensures all steps are completed. For instance, at OpenLoop, we’re typically able to complete the credentialing process in just 2 to 4 weeks.
Red flag: When you ask about their credentialing process and you notice gaps that could lead to constant back-and-forth when verifying information. This ultimately delays the credentialing turnaround time.
4. Reporting
When credentialing is done in-house, checking the status is simple, but that’s unfortunately not always the case when you outsource to CVOs. You should inquire if they’ll send you reports and, if so, how often. OpenLoop sends detailed weekly status reports so our clients know exactly what’s going on. This allows us to work with our clients to resolve any potential issues quickly and efficiently.
Red flag: The CVO doesn’t send status reports or does so on a monthly or quarterly basis.
5. Recredentialing: ongoing review and maintenance
If your healthcare company needs assistance with re-credentialing and other related matters, you should inquire about what technology they have in place to keep track of these things. For OpenLoop’s provider network, our HIPAA-compliant technology allows us to ensure that CAQH profiles are up-to-date and provider licenses are in good standing. We can even assist with CME monitoring, so providers stay current about modern medicine and meet state requirements.
Red flag: Their technology seems dated or lacks the ability to send timely reminders and notifications so you avoid lapses.
5. Fees
Like any investment, you’ll want to ensure the CVO you consider aligns with your budget. But part of this hinges on their transparency about pricing. Some CVOs have hidden pass-through fees, subscription requirements and spontaneous mark-ups that aren’t revealed until after you’ve signed an agreement.
At OpenLoop, we pride ourselves on our transparency. OpenLoop partners enjoy competitive industry pricing, and we don’t sacrifice quality to achieve that.
Red flag: The CVO fails to share additional fees and surcharges that may occur before you sign on the dotted line.
6. Credentialing experience
Not every credentialing process is the same. For instance, Medicaid and Medicare’s processes are known to be lengthy and require additional hoops not found in other payer plans. Therefore, you want a CVO with extensive credentialing experience with both private and public payers. They’ll know about common challenges and how to prevent them so you avoid unwanted hiccups with payers.
Red flag: The CVO has limited experience with different private and/or public payers.
The right CVO can streamline your provider operations
Selecting a CVO shouldn’t be taken lightly, as credentialing itself is one of the most important processes in healthcare. The right CVO can set a scaling business up for success, while the wrong one can lead to fines, reputational damage and patient safety concerns.
Our dedicated credentialing experts at OpenLoop and our unrivaled technology allow for streamlined credentialing. Just imagine how much your company could benefit from our fast yet diligent screening process. However, it doesn’t stop there. We offer a full range of white-labeled support services, including access to our expansive, pre-vetted, NCQA-accredited provider network. Built to scale with your business without any of the in-house headaches.
Want to learn more? Contact us today!
Our full suite of white-labeled virtual care services includes: