Run primary-source verification (PSV)

For: Credentialing Coordinator · Time: 15–30 min per provider · Frequency: Pre-submission for every payer application + every 36 months for recredentialing

Trigger

You're about to submit an application AND the payer requires recent (typically ≤30 day) PSV. Or recredentialing is due (most payers want fresh PSV every 24–36 months).

Outcome

You have current, dated verifications on file for: state license(s), DEA registration, board certification(s), education (medical school + residency), malpractice claim history, OIG/SAM exclusion screen. All are saved as attachments on the provider record with the verification date stamped.

Where

• Compliance → PSV
• Compliance → Exclusions
• Provider detail → Documents tab

Steps

1. Open Compliance → PSV → pick provider. The page lists what's required and what's on file with expiration dates.
2. License verification. Go directly to the state board's license lookup tool (linked in Reference → State Boards per state). Save the result as a PDF (browser → print → save to PDF). Upload to provider's documents with type=license_verification. Date stamp it (most boards show a "verified on" timestamp).
3. DEA verification. DEA Diversion Control website → look up by DEA number. Same save-as-PDF + upload routine.
4. Board certification. Specialty-specific:
   • ABMS member boards — ABMS Certification Matters (certificationmatters.org)
   • AOA — osteopathic.org
   • International / specialty — check the issuing body
   • Most boards print a "verified" stamp; save the PDF.
5. Education. Medical school via AAMC (some payers accept) or contact the registrar directly. Residency via the program; this often requires a paper or fax form. Hold the response in the docs folder.
6. Malpractice. Request claim history from the provider's current carrier. They'll fax a Letter of Good Standing within ~2 weeks. Upload with date.
7. OIG/SAM exclusion screen. Compliance → Exclusions → screen by provider name + NPI. Result is captured automatically with date. Re-screen monthly per CMS guidance (the platform reminds you).
8. Update PSV summary. Compliance → PSV → mark "verified" for each completed item. Date auto-fills.
9. Generate the PSV packet if the payer wants a combined PDF. Provider detail → Generate Packet → checkbox the PSV items → download.

Watch-outs

• "Primary source" means the issuing body, not an aggregator. A screenshot of a board's website is fine. A screenshot of CAQH showing the board cert is NOT — CAQH is secondary. Same for ABMS dashboards — they are primary; sub-aggregators are not.
• The 30-day clock is real. Most payers reject PSV older than 30 days at submission. If your application sat in draft for 60 days, you need to re-verify before submitting.
• OIG exclusions can flip MID-month. Even if a provider was clean on day 1, they can land on the LEIE list on day 15. Re-screen monthly. Some payers want re-screening monthly per CMS Compliance Program guidance.
• PSV docs contain PHI/PII. Education records, board certs, malpractice histories — handle as sensitive. Don't email them; upload directly via the platform's encrypted document handler.
• Some states have practitioner profiles (e.g. NY Office of Professional Discipline) that show disciplinary actions. Always check, even if the license is "active." A clean license + an active investigation is a red flag.

Related jobs

• Work an application from intake to credentialed — PSV is the prereq
• Renew a license — license PSV needs to be re-pulled after each renewal

Something on this page doesn’t match what you see in the app? Email support@credentik.com and we’ll fix the guide.