Credentialing is a judgment about whether a provider is qualified. Primary source verification is what makes that judgment trustworthy: each key credential is confirmed with the organization that issued it, and the confirmation is recorded.
Why it matters
Documents can be outdated, altered or simply wrong. A license may have been restricted since the copy was made; a board certification may have lapsed. Health plans, hospitals and accrediting bodies require primary source verification so that decisions rest on current information from the source, and so the organization can show its work in an audit.
What gets verified, and where
Exact requirements depend on the organization, the accreditor and the provider type, but these elements are commonly verified at initial credentialing and again at recredentialing:
| Credential | Typical primary or accepted source |
|---|---|
| State license | The state licensing board, usually by its online lookup or a written confirmation. Nurses may be verified through Nursys, which takes data from participating boards. |
| DEA / state controlled substance registration | The DEA or the state agency that issues the registration. |
| Board certification | The certifying board, or a source the accreditor accepts for that board. |
| Education and training | The school or training program, or a source the accreditor accepts as equivalent. |
| Work history | Usually reviewed from the CV and application, with gaps explained. Some organizations verify recent employment directly. |
| Malpractice claims history | The National Practitioner Data Bank (NPDB) or the malpractice carrier. |
| Sanctions and exclusions | State board actions, the OIG LEIE, SAM.gov and state Medicaid lists. |
| Medicare opt-out | The CMS opt-out affidavit list. |
Your accreditor’s current standards are the authority on which sources are acceptable for each element. Always check them rather than relying on a summary.
Verification time limits
A verification is only useful if it is recent. Accrediting bodies set a maximum age for each verification at the time the credentialing decision is made. NCQA’s September 2025 guide to its credentialing programs lists limits between 90 and 180 days depending on the element and on whether the organization holds Credentialing Accreditation or Certification. See our NCQA standards overview for the table.
In practice this means verifications should be done close to the decision, and a file that sits waiting for a committee may need parts re-verified.
How to document a verification
For each element, the file should show:
- What was verified (the credential and its number)
- The source, and how it was checked (online lookup, letter, phone, data feed)
- The date of verification
- Who performed it
- The result, including any discrepancy and its explanation
- Evidence, such as a dated screenshot or the source’s confirmation
Common mistakes
- Accepting a provider-supplied copy as verification.
- Verifying the license in one state but not every state of practice.
- Letting verifications age past the time limit before the decision.
- Not recording discrepancies, or not explaining them.
- Saving screenshots without the date and source visible.
Primary source verification in Credentik
Every credentialing file in Credentik has a verification checklist covering these elements. Where Credentik already has a verified result, such as exclusion screening, the NPI registry, CAQH attestation or a state board record, it prefills the element with the source and time. Each element has a validity window, and a decision is refused while a required element is pending, expired or an unexplained discrepancy. See credentialing and PSV.