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Feature · Credentialing

Credentialing and primary source verification, in order

Every provider gets the checklist that fits their credential, states and payers. Credentik prefills the verifications it can check itself, shows what is still missing, and routes the finished file to a clean-file sign-off or your committee.

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Requirement engine

A checklist that knows what each provider needs

A psychiatric nurse practitioner enrolling with Medicaid in two states needs different evidence from a therapist joining one commercial plan. Credentik builds each provider’s checklist from rules that apply by credential, practice state, payer and practice client, so your team is not keeping five versions of the same spreadsheet.

Every requirement points to the exact record that proves it: an active license in that state, a current DEA registration, malpractice coverage at the right limits, a recent CAQH attestation, a clean exclusion check. Nothing is matched by guessing from a document name.

Readiness score

A score per provider, per practice client and for the whole agency, with the exact items that are missing, pending or expiring.

  • Blocking, required and recommended items, so the urgent gaps come first
  • Due dates anchored to the application or recredentialing date
  • Missing documents can trigger a document request to the provider
Primary source verification

Confirm instead of retyping

Each credentialing file has a verification checklist: state license, DEA or CDS, board certification, education and training, work history, malpractice history, liability insurance, OIG, SAM, state Medicaid sanctions, Medicare opt-out, NPI and the signed attestation.

Where Credentik already has a verified result, it prefills the element with the source and the time it was checked. Your team works the rest, attaches the evidence and records discrepancies with a written explanation.

Validity windows

Each element has a validity window. A verification that has aged out by the decision date is flagged, so a file is not approved on stale checks.

Nothing approved with gaps

A decision is refused while a required element is pending, expired or an unexplained discrepancy. Decisions are kept as permanent records, and a final decision freezes the file.

Committee and clean files

Route each file to the right decision

When every required element is complete, a file with no discrepancies and no unexplained work-history gap can go to a clean-file sign-off by a designee, if your policy allows it. Everything else goes to the committee queue.

Build the meeting agenda from files awaiting review, record attendance and voting members, handle conflict-of-interest recusals, check quorum per file, record each decision and have the chair attest the minutes.

An audit trail you can hand over

  • Who verified each element, from which source, and when
  • Discrepancies with their explanations
  • Committee minutes, quorum and recusals per file
  • Every change recorded in the audit log

Works with the rest of the file

Verification sits next to everything else your team does for a provider.

Payer enrollment

When a file is approved, the application moves forward on the enrollment board.

Payer enrollment

Exclusion screening

OIG, SAM, state Medicaid and Medicare opt-out results flow into the checklist.

Exclusion screening

Recredentialing

The next cycle opens with a prefilled file and the same checklist.

Recredentialing
Questions

Frequently asked

What does Credentik verify automatically?
Where Credentik already holds a verified result, it prefills the matching element on the verification checklist with the source and the time it was checked: for example OIG and SAM screening, state Medicaid and Medicare opt-out screening, NPPES, and state license board results in the states where board data is imported automatically. Anything a person has already worked is never overwritten. Everything else is verified by your team and recorded on the same checklist.
Can we use our own checklist?
Yes. Credentik ships a platform checklist, and each agency can switch items off, change them or add its own requirements, including per credential, state, payer or practice client.
Do we have to use a credentialing committee?
No. A file with no discrepancies can go to a clean-file sign-off by a designee if you allow it. Files with discrepancies or unexplained gaps go to the committee queue, where you build the agenda, record attendance, quorum and recusals, and capture each decision.
Is primary source verification the same as payer enrollment?
No. Primary source verification confirms a provider's credentials with the issuing source. Payer enrollment is the application to a health plan to bill as an in-network provider. Credentik keeps both, side by side, for each provider. Our guide to credentialing vs privileging vs enrollment explains the difference.

Keep reading

GuideWhat is primary source verification?What PSV is, what gets verified, the sources, time limits and documentation.Read more GuideNCQA credentialing standards, in plain languageAccreditation vs Certification, standard categories, time limits and the 36-month cycle.Read more FeatureLicense verification and expiration trackingState board verification plus expiration alerts for licenses, DEA, boards and malpractice.Read more

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