How Does Primary Source Verification Work?

What is Primary Source Verification?

Primary Source Verification (PSV) is the process of verifying a provider’s qualifications and competencies by reaching out to and obtaining information from the issuing authority or original source of that information. 

Credentialing professionals conduct PSV to confirm the following information about a provider: 

  • Medical education
  • State medical license
  • Federal and state Drug Enforcement Agency (DEA) certificates
  • Board certifications
  • Residency programs
  • Malpractice history
  • Sanctions and exclusions
  • Professional work history

A ‘primary source’ is the originating institution, organization, or individual of the provider’s degree/diploma, training experience, work experience and other qualifications. Commonly consulted primary sources include:

  • Universities
  • Medical schools
  • Licensing boards
  • Specialty training or residency programs
  • State medical boards
  • Medical councils
  • NPI Registry
  • Drug Enforcement Agency (DEA)
  • SAM
  • Office of Inspector General (OIG) Database
  • National Practitioner Data Bank (NPDB)
  • Former employers (e.g., hospitals, medical staff offices, etc)
  • Professional associations
  • Social security administration death master file

In cases where PSV cannot be performed, verification could be done from a non-primary source – i.e., designated equivalent sources (DES) – but under specific conditions set by accreditation agencies. When the conditions are met, the following accreditation agencies could be considered as credible and accurate as the original issuer:

  • American Medical Association (AMA)
  • American Board of Medical Specialties (ABMS)
  • Educational Commission for Foreign Medical Graduates (ECFMG)
  • American Osteopathic Association (AOA)
  • American Academy of Physician Assistants (AAPA)
  • Federation of State Medical Boards (FSMB) Disciplinary Action Databank

Any organization that needs to carry out provider credentialing will perform PSV. However, the PSV work can be done internally or, alternatively, outsourced to a third-party certified Credentialing Verification Organization (CVO).

Why is Primary Source Verification Important?

PSV is a crucial step in the provider credentialing process as it is the first line of defense to ensure patient safety. Verifying a provider’s professional background must be done correctly and efficiently to filter bad actors as well as avoid delays, claim denials, and other costly risks.

Likewise, accreditation agencies like the National Committee for Quality Assurance (NCQA) and others require PSV. This is important because payers and other key stakeholders utilize the standards set by the NCQA and others as part of their credentialing process. They won’t work with providers who don’t comply with those standards. Similarly, state licensing boards and others also require PSV before engaging a provider. 

If you’re going to work with a CVO it’s important to ensure that they are NCQA-certified (like Verifiable), which gives you reassurance that PSV is being done to their standards. For organizations that want to keep their credentialing entirely in-house, a reliable method of obtaining PSVs (like automation software) is essential to getting NCQA-certified.

You Need PSV for Provider Credentialing

Healthcare organizations and payers alike will not work with a practitioner until they verify their qualifications and competencies. Consulting the original issuing bodies of the practitioner’s education or training is a critical way of verifying that information.

It’s important to verify that information as discrepancies and gaps can put patients at risk, result in payment delays, and lead to liability issues. Provider organizations like hospitals want to avoid those risks.

Likewise, payers – be it private sector or government-supported – will not reimburse or issue payments to providers who aren’t properly credentialed. Lack of PSV could result in denials or delays in payments, which can lead to revenue loss for the provider.  

Regulators Care About Primary Source Verification

Government bodies also require healthcare organizations to perform PSV when validating their practitioners’ licenses. It’s important to establish robust PSV processes at the start of the credentialing process and afterwards via continuous monitoring. The latter is important for ongoing compliance and re-credentialing approximately two years later. 

Accreditation Agencies Value Primary Source Verification

Payers use an accreditation agency’s standards to measure a provider’s ability to deliver safe and high-quality care to patients. In turn, these accreditation agencies generally require PSV as part of their compliance guidelines. Failure to meet these standards can lead to payment delays or denials. 


Payer organizations use the NCQA’s standards for PSV when credentialing. Thus, when a provider complies with the NCQA’s PSV standards, they’ll be able to apply for support from multiple payers more efficiently. 

The Centers of Medicare & Medicaid Services (CMS)

The CMS is a federal agency that provides healthcare coverage to millions of Americans. CMS requires healthcare organizations that take part in its programs to verify the credentials of their providers through PSV.

State Licensing Boards

State licensing boards are responsible for licensing healthcare providers in each state. Many state licensing boards require healthcare providers to have their credentials verified through PSV before they can be licensed to practice.

The Joint Commission

Organizations seeking accreditation from The Joint Commission must perform PSV for their practitioners. In fact, The Joint Commission places the responsibility for PSV on the provider organization, not the licensed individual practitioner.

Utilization Review Accreditation Commission (URAC)

URAC is a voluntary but widely recognized accreditation among payers. Like the NCQA, complying with URAC’s PSV requirements gives providers the flexibility to readily apply for reimbursements from multiple payers in an efficient way.

Primary Source Verification Challenges

PSV is a crucial step of the credentialing process, but it requires working with large volumes of data and documentation from disparate sources. Manually performing PSV is a labor-intensive and time-consuming process; it’s inefficient as well as high-risk in terms of delays and errors. These risks affect everyone involved in the delivery and receipt of care, be it patients, providers, or payers. 

Manual processes typically involve looking up licenses, reviewing state boards, and referencing databases and other digital sources. In cases where the issuing body doesn’t have a digital presence, PSV must be done through phone, fax and/or written correspondence. In these cases, PSV can take 90-120 days, which is a significant amount of time and can lead to costly administrative overhead and operational costs for healthcare organizations. This also exposes these organizations to inefficiencies – like data entry errors, misinterpretation of information. 

These issues lead to delays in providing care to patients, onboarding qualified healthcare and medical professionals, and getting reimbursement from payers. These inefficiencies can amount to costs of thousands of dollars per provider each day.

Moreover, the rigorous nature of PSV can impose excessive strains on the organization’s staff, who already have a demanding workload. Thus, manual PSV work could hinder staff from performing their other essential duties effectively.

How to Efficiently Perform Primary Source Verification

Speed and accuracy are two crucial elements of PSV. Through the use of tools and processes, every healthcare organization and payer can perform PSV efficiently without burdening their staff or distracting from their core functions, i.e., to deliver care.


83% of healthcare organizations have fully or partially automated their PSV processes. The landscape has largely moved beyond leaning on manual PSV processes; but automation is not a panacea in of itself – its effectiveness depends on your partner and vendors.

Using a software platform for PSV is a good start, but you must ensure that it connects or leverages the hundreds of primary sources you need to review. Thus, this platform needs to connect with state licensing boards, board certifications, the NPI, OIG, NPDB and others. In addition, the platform should carry out real-time checks automatically with minimal manual intervention or input.

You also need a platform that will let you review and validate information within seconds. It should also be robust enough to help with reporting and auditing for compliance needs. For example, does it capture proof of the primary source? Does it provide monitoring following the initial credentialing process and help with re-credentialing several years later? 

Working with a CVO can also be a good route; but again, you must ensure that the CVO has the necessary data access or linkages to fully leverage the benefits of automation and doesn’t result in delayed turnaround times due to manual verifications on their end.

Reducing PSV Errors and Delays

Eliminating manual processes by properly leveraging automation (i.e., having a platform and/or partner that fully connects to your primary sources) is a must-have to reducing the risk of PSV errors. You can also add the following steps to your process to further strengthen your PSV for its accuracy and timeliness. 

  • Use a standardized process: Implementing a standardized process for PSV ensures uniform credential verification; reducing errors and delays.
  • Use a secure, centralized electronic system: By automating tasks such as data entry and verification through a secure electronic system, errors and delays can be minimized.
  • Leverage an API-based PSV solution: Using an API-based PSV solution can enable your organization to embed real-time verifications and ongoing monitoring directly into the core systems of record your organization already uses.
  • Train staff on PSV procedures: Educating staff on PSV procedures helps them understand its importance and informs them how to perform it correctly.
  • Be proactive: Verifying credentials early in the process helps identify potential problems and leads to faster revenue. If a response from an issuing organization is delayed, immediate follow-up ensures quicker verification process completion.
  • Keep records: Maintaining comprehensive records of all PSV requests and responses ensures transparency and a clear audit trail, and complies with state & federal requirements to store credentialing files for a set period of time.

Ultimately, you need a combination of both effective processes and tools to efficiently carry out PSV. You can leverage both out-of-the-box by working with a partner like Verifiable. 


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Why Verifiable?

Verifiable is the leading solution for automated primary source verifications, and provider network management. The unique technology integrates over 3,000+ sources to complete PSVs according to NCQA standards, with the click of a button. Healthcare organizations of all shapes and sizes use Verifiable to credential 4X faster, take control of their provider data, and create an experience that providers respect and appreciate.

Frequently Asked Questions (FAQ)

What can I verify using PSV?

Below are primary sources that are commonly verified:


Educational institutions

  • Medical schools
  • Residency Programs
  • National Student Clearinghouse (NSC)
  • Education Commission for Foreign Medical Graduates (ECFG)

Professional certifications, licenses, and associations

  • Continuing education
  • Training programs (fellowship, internship, etc.)
  • Federation of State Medical Boards
  • Affiliations
  • Professional certifications

Past employers/hospitals

  • Former employers


  • Peer references
  • Professional connections

State and federal agencies

  • State licenses
  • Boards like (, AOA, ABMS, ABIM)
  • National Provider Identifier (NPI) registry
  • Drug Enforcement Administration (DEA) license
  • Social Security Administration’s Death Master File (DMF)
  • OIG (Office of Inspector General)
  • SAM (System for Award Management)
  • OFAC (Office of Foreign Assets Control)
  • National Practitioner Data Bank (NPDB)
  • National Supplier Clearinghouse (NSC)
  • Background checks
  • Criminal history
  • Military Personnel Record
  • State Certifications List of Excluded Individuals/Entities
  • Medicaid Sanctions list
  • Medicare Opt-Out list
  • Medicare Preclusion List
  • Medical Malpractice loss runs report

What methods can I use for PSV?

There are several ways to verify credentials properly:

  • Direct correspondence: This involves contacting the issuing organization directly requesting credential verification, usually by documented telephone conversation, fax, email, or online.
  • Digital verification: This involves using secure platforms, like Verifiable, that provide access to verified provider information and their credentials. However, it’s important to note that not all platforms offer real-time, automated verifications and many rely on manual work behind the scenes. Additionally, coverage across states, sources and provider-types can be a significant point of differentiation.
  • Third-party verification services: CVOs are third-party organizations with access to different primary source data, allowing them to verify provider information efficiently, accurately, and quickly. CVOs like Verifiable are credentialed by organizations like NCQA to ensure they adhere to the highest levels of quality.

How frequently do I need to perform PSV?

The healthcare organization or the CVO they hired is responsible for monitoring expiration dates and tracking credential statuses. They must have the tools to ensure they do not miss any expiration date.

The Joint Commission requires employers to perform a PSV at a minimum at hire and at the time they are scheduled for renewal (or upon the expiration of the credentials). Since NCQA and The Joint Commission also requires re-credentialing at least every three years, and PSV is a crucial step in re-credentialing, then health organizations are expected to perform a PSV on a regular basis.

To ensure NCQA compliance and adherence to delegated agreements with payers, many organizations also perform ongoing monthly monitoring of license-expirations and relevant