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With rising regulatory scrutiny and expanding provider networks, healthcare credentialing is more demanding than ever. This means that efficiency in PSV has become indispensable, as inaccuracies or delays can lead to compliance penalties, reputational damage, and even jeopardize patient safety.
In this article, you’ll discover the best way to verify primary sources.
As you read, you’ll learn the differences between manual and automated PSV, weighing their costs and benefits to help healthcare organizations decide which approach suits their needs.
Understanding Manual Primary Source Verification
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Manual PSV has been the traditional industry approach for decades. It relies on human effort to verify provider credentials directly from the issuing sources.
For example, verifying a medical license may involve calling the state licensing board, waiting for confirmation, and recording the details manually. This process requires a dedicated team familiar with regulatory standards and equipped to handle communication with multiple sources.
Documentation is stored in physical files or local digital systems, which must be organized for easy access during audits. While this method has been the industry standard for decades, it requires significant time and resources.
Key Components of Manual Primary Source Verification (PSV)
Manual PSV must adhere to stringent industry standards set by regulatory bodies such as The Joint Commission and state licensing boards. These standards dictate what must be verified, how records should be maintained, and the timelines for completing verifications.
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Some of the requirements for manual primary source verification (PSV) include the following components:
1. Qualified Personnel
Manual PSV requires trained credentialing specialists who understand industry regulations and compliance requirements. These professionals need excellent organizational skills and attention to detail to handle the complexity of verifying multiple credentials
2. Communication Tools
Manual verification depends on reliable communication tools, such as phones, email systems, and fax machines. These tools are important for contacting primary sources such as licensing boards, universities, and certification bodies
3. Time and Administrative Support
Manual processes are time-intensive and require significant staff hours for follow-ups, documentation, and error resolution. Administrative support is also important for organizing files, managing communication logs, and ensuring smooth workflows
4. Record-Keeping Systems
Accurate and secure storage of verification records is important for compliance. Many organizations rely on physical filing systems or basic digital storage solutions. These systems must allow easy retrieval of records during audits or reviews
5. Access to Primary Sources
Credentialing teams must have clear access to primary source databases, state licensing boards, and accrediting bodies. Often, this involves obtaining permissions or subscriptions to access specific data
Benefits of Manual PSV
Manual PSV has several advantages, especially in scenarios that require flexibility and judgment, such as:
1. Human Oversight and Judgment
In cases where provider details are incomplete, credentialing specialists can assess situations individually and resolve issues that an automated system might flag as invalid
2. Relationship Building
By directly interacting with primary sources, such as licensing boards or universities, organizations can build stronger connections, leading to smoother verifications over time. For example, smaller healthcare providers might develop relationships with local boards, making future credentialing requests faster and more efficient
3. Handling Unique Situations
Manual PSV provides the flexibility to address unusual cases, such as verifying international credentials or handling rare certifications. These situations often require customized approaches that automated systems may not be equipped to handle
Challenges and Limitations of PSV
Despite its strengths, manual PSV has certain limitations that can hinder efficiency:
1. Time-Intensive Nature
Manual verification requires credentialing specialists to complete each step individually. Tasks such as sending multiple follow-up emails or waiting for responses can extend verification timelines, delaying credentialing and potentially affecting time-to-hire metrics
2. Human Error Risks
Manual entry and communication always involve risks of inaccuracies. A missed detail, such as an incorrect license number, can delay the process
3. Scalability Challenges
As organizations grow, the volume of verifications increases, straining teams that rely solely on manual processes. This often results in burnout and higher turnover among credentialing staff
4. Storage and Accessibility Issues
Retrieving physical records quickly becomes challenging during audits or compliance checks, adding unnecessary stress to already-burdened teams
The Rise of Automated Primary Source Verification
Automated systems can now integrate directly with primary source databases to streamline verification processes. This provides speed and accuracy that manual methods struggle to achieve.
Technology Behind Automation
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Automated PSV systems use advanced tools like APIs (Application Programming Interfaces) to connect with databases from licensing boards, educational institutions, and certifying bodies.
For example, a provider’s license can be verified in real-time through an API connection to a state medical board’s database, reducing the need for manual outreach.
Emerging technologies, like blockchain, are also being explored to improve data security and ensure the integrity of verification records. These systems are designed to minimize vulnerabilities, safeguarding sensitive provider information during verification.
Key Advantages of Automated PSV
One of the most compelling benefits of automated PSV is speed. What might take days or weeks with manual methods can often be completed in hours or minutes. This speed is particularly beneficial during peak hiring when credentialing demands are high.
Other advantages include:
1. Standardization of Processes
Automation ensures that every verification follows the same standardized workflow, eliminating inconsistencies that might arise from human error
2. Real-Time Tracking and Reporting
Automated tools provide real-time updates on the status of verifications. This enables credentialing teams to monitor progress and address delays proactively
3. Scalability for Growth
Automated systems can also handle large volumes of verifications without requiring additional staff, making them ideal for growing organizations with large provider networks
Potential Drawbacks of Primary Source Verification
Automation, although advantageous, is not without its challenges:
1. Initial Costs
Implementing an automated system involves making upfront payments for software licensing, integration, and staff training. For smaller organizations without enough funds, these costs may be prohibitive
2. Dependence on Technology
Automated PSV relies on uninterrupted access to technical infrastructure. System outages or compatibility issues with primary source databases can hinder verification
3. Staff Adaptation
Staff accustomed to manual processes may face difficulty with automated systems. Without proper training, using automated tools to the fullest would be difficult
Cost-Benefit Analysis of Manual vs. Automated PSV
Organizations must evaluate both direct and hidden costs, along with the time and resources needed for manual versus automated PSV.
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1. Direct Costs
Manual PSV incurs the following costs:
- Staff salaries: $40,899 per staff
- Training: $995 per month
- Physical or digital storage costs: $35-$100 per month
These expenses can add up, particularly for organizations managing large provider networks.
On the other hand, for an automated PSV, investments in software licensing, implementation, and maintenance would likely cost approximately $70,000 - $100,000 annually.
While the upfront costs of automation are higher, they often result in long-term savings by reducing staffing needs and minimizing errors.
2. Time Investment
Manual PSV can take several days per application (15 to 20 working days), consuming valuable staff hours and extending credentialing turnaround times.
In contrast, automated systems complete verifications much faster (within minutes and hours), allowing staff to focus on other priorities. Automation offers a clear advantage for organizations that want to reduce time-to-hire metrics.
ROI Consideration For PSV
When evaluating ROI, we advise that organizations consider both short-term and long-term impacts.
Manual PSV may initially seem cost-effective, but inefficiencies and errors can lead to hidden costs, such as delayed reimbursements or compliance penalties leading up to $100 to $50,000 per violation.
While automation requires a higher initial investment, it delivers productivity gains, error reduction, and scalability, making it a more sustainable solution for growing organizations.
According to research, the healthcare industry avoided $193 billion in costs through automation in 2023. The savings potential of additional automation was estimated at $18.3 billion.
Organizations using automated PSV can also avoid costs associated with compliance penalties or delays in payer enrollments.
Best Practices for Implementation
Below are some of the best practices for implementing manual and automated PSV.
1. Hybrid Approaches
A hybrid approach combines manual and automated PSV. For example, routine verifications can be automated, while complex cases requiring human judgment are handled manually. This approach ensures efficiency without sacrificing flexibility or accuracy.
For organizations that intend to use this approach, success depends on clear workflows that show which tasks are automated and which are handled manually. Start by mapping out the entire verification process, identifying where human intervention adds value. For instance, automated systems can flag discrepancies, which are reviewed and resolved by a trained credentialing specialist.
Risk-based verification strategies are also useful in the hybrid model. High-risk credentials, such as specialty certifications, can undergo manual review, while low-risk verifications are automated.
Ensure you establish regular audits and validation checks to meet the compliance standards for manual and automated PSV. These measures can include reviewing a sample of automated verifications to confirm accuracy or conducting periodic staff training on best practices.
2. Change Management
It is important to ensure your employees understand how to use automated tools, recognize when manual intervention is necessary, and align their workflows with new processes.
For instance, a team switching to a hybrid model might undergo training to interpret system-generated reports and handle flagged discrepancies.
Healthcare organizations should also create detailed process guides outlining each step of the verification workflow, including when to escalate issues and how to address common challenges.
To assess an approach's effectiveness, consider regularly tracking key performance metrics. These metrics include average verification times, error rates, and compliance audit results, which provide insights into areas for improvement. For example, the organization can investigate potential bottlenecks if turnaround times remain high despite automation.
Making the Right Choice for Your Organization
When deciding between manual and automated PSV, healthcare organizations should evaluate their size, credentialing volume, budget, and technical capabilities.
Here’s how to evaluate your needs and identify the best method for your organization.
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1. Assess Your Organization’s Needs
Start by considering your organization’s current capacity and future growth plans. Smaller organizations with limited staff and a manageable number of credentialing applications may find manual processes or a hybrid model sufficient for their needs.
For example, a small clinic handling five to ten new provider verifications monthly might opt for manual PSV, given its lower upfront costs and manageable workload.
On the other hand, larger healthcare systems or organizations experiencing rapid growth will often find automated PSV more practical.
Automation provides scalability, allowing these organizations to handle hundreds of verifications without overburdening their staff. If your team struggles with turnaround times, automation can streamline operations and support your expansion goals.
2. Consider Your Budget
While automated PSV like Assured requires an initial investment in software, and system integration, it offers significant cost savings over time by reducing the need for additional staff and minimizing errors. Organizations should also weigh the hidden costs of manual PSV, such as staff turnover, increased error rates, and time lost to inefficiencies.
Performing a cost-benefit analysis can clarify whether your budget supports automation in the short term or if a phased implementation might be a better strategy.
3. Consider Your Technical Capabilities
Your organization’s technical readiness plays a role in choosing between manual and automated PSV. Automation requires infrastructure, including compatible credentialing software, secure data systems, and technical support for troubleshooting and updates.
If your organization lacks these resources, adopting automation may require additional investments in IT systems and staff training.
For organizations with limited technical expertise, starting with a hybrid model might be more feasible. You can gradually integrate automation without overwhelming your team or resources by automating routine verifications and reserving manual processes for complex cases.
4. Develop an Implementation Checklist
A detailed implementation plan will help you succeed regardless of your method (manual or automated). This plan should outline key factors such as timelines, resource allocation, and measurable success metrics.
For instance, if transitioning to automated PSV, set clear goals, such as reducing verification times by 50% or eliminating errors within six months.
Assign roles and responsibilities to team members and ensure they receive adequate training to operate new systems.
If sticking with manual processes, focus on improving workflows, minimizing redundancies, and addressing bottlenecks in your current setup.
Wrapping Up
So, which PSV should you choose? That depends on your organization’s needs and goals. However, we highly recommend embracing automation or adopting a hybrid approach.
Not sure how to do this? Consider using Assured. Assured is an all-in-one platform for provider network management. We simplify the credentialing, licensing, payor enrollment, and network management processes.
With a focus on automation and transparency, we help providers save time and streamline administrative tasks like provider verification, licensure applications, and payer integrations.
Our tools enable faster and more efficient management of healthcare networks while ensuring compliance and reducing errors. Our API-first approach also allows for seamless integration with your existing systems.
