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Q&A: Which items on an application need primary source verification?

Credentialing & Verification Update, June 20, 2007

A: Verify the following pieces of information by contacting their sources (or issuers):

• Medical school graduation
• Completion of a residency and/or fellowship program
• Information from all prior and current professional liability insurance carriers concerning claims, suits, and settlements, and restrictions or limitations of coverage during the past five years
• The applicant's clinical work experience during the past six to 12 months
• Licensure status in all current or past states of practice
• Information from the Board Action Data Bank of the Federation of State Medical Boards
• The American Medical Association's Physician Masterfile Profile or the American Osteopathic Physician Profile
• The National Practitioner Data Bank for sanctions and malpractice claims; information from the Education Council for Foreign Medical Graduates (if applicable)
• Federal Drug Enforcement Administration/State Controlled Dangerous Substance certificate (if needed)
• The Office of Inspector General's list of individuals/entities excluded from Medicare, Medicaid, and other federal payment programs
• Relevant work history (hospital appointments, clinical privileges, etc.) and professional societies/organizations
• Other information as deemed necessary

Editor's note: Questions and topic suggestions can be e-mailed to CVU at mcoler@hcpro.com. We'll find an expert or resource to tackle the credentialing or verification issues that are challenging you.

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