CAQH Credentialing and ProView Profile Management
The profile every commercial payer pulls from
Credentialing playbook
Primary Source Verification Services
Primary source verification confirms a provider's credentials directly with the body that issued them. We run PSV for hospitals, groups and delegated entities to NCQA and Joint Commission standards, with documented evidence for every element.
7-14 daysto onboard your practice end to end
Weeklystatus report on every open application
50 statesMedicare, Medicaid and commercial panels
About 4 minute read. Reviewed September 2026 by the ClainetRCM credentialing team.
On this page
- Overview
- Where it goes wrong
- What we handle
- Elements verified and the source we use
- How the work runs
- Questions
- Read next
Want us to run it?
Send your roster and target payers; we map the gaps at no cost.
A copy of a license proves that a document exists, not that it is valid. Primary source verification goes to the issuing board, the school, the certifying body and the federal databases to confirm each credential is real, current and unrestricted. Payers do this before they credential you; hospitals and groups that credential their own providers must do it themselves.
ClainetRCM performs PSV as a standalone service for medical staff offices and delegated credentialing programs, and as part of every payer application we prepare, so problems surface before a committee finds them.
Where this usually goes wrong
Verification done from copies
Accepting a photocopied license instead of querying the board fails an NCQA or Joint Commission audit and can expose the organization if the credential was altered.
NPDB queries skipped
The National Practitioner Data Bank holds malpractice payments and adverse actions. A missed query means a committee approves a provider without the full picture.
No evidence trail
Auditors want the date, source and method of every verification. Verifications done by phone with no record do not count.
What ClainetRCM handles
One coordinator owns the file from intake to effective date, so you always know who to call and what is outstanding.
- State license verification with every board where the provider is licensed
- Education and training verification with schools and residency programs, or through AMA and AOA profiles
- Board certification verification with ABMS, AOA and specialty boards
- DEA and state controlled substance registration verification
- NPDB self-query or entity query, OIG and SAM exclusion checks, and Medicare opt-out review
- Dated verification report with source, method and result for every element
Elements verified and the source we use
| State license | State licensing board, online verification or written confirmation |
|---|---|
| Medical education | School registrar, or AMA Physician Profile / AOA Profile for MDs and DOs |
| Residency and fellowship | Program director confirmation or AMA/AOA profile |
| Board certification | ABMS, AOA, NCCPA, ANCC, AANP, ABPN and other certifying bodies |
| DEA and CDS | DEA registration lookup and state CDS boards |
| Sanctions and exclusions | NPDB, OIG LEIE, SAM.gov, state Medicaid exclusion lists |
| Malpractice history | Carrier confirmation and NPDB report |
PSV is the foundation for hospital privileging, delegated credentialing and compliance with NCQA credentialing standards.
How the work runs
The sequence is the same for every payer and provider type; what changes is which documents and portals each step touches.
- 1
Intake and gap review
Licenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
- 2
Profile setup
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- 3
Application submission
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- 4
Follow-up on a fixed cadence
Payers are contacted on a schedule. Requests for more information are answered the same business day.
- 5
Approval, contract and handoff
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
Frequently asked questions
The organization that issued the credential: the state board for a license, the school for a degree, the certifying board for certification. Recognized designated equivalent sources, such as the AMA Physician Profile for education, are accepted by NCQA and the Joint Commission for specific elements.
NCQA requires most verifications to be no more than 180 days old at the time of the credentialing decision. Licenses and DEA must be current. We time verifications so they are fresh when the committee meets.
Hospitals and ambulatory surgery centers credentialing medical staff, groups and IPAs with delegated credentialing agreements, and practices that want to catch problems before a payer does.
Yes. Entities registered with the NPDB can query directly; individual providers can self-query. We handle both and include the result in the verification report.
Read next
NPI Registration and NPPES Record Management
Type 1 and Type 2 NPIs done correctly
Provider Re-Credentialing Services
Renewals before the panel drops you
Hospital Credentialing and Privileging
Medical staff applications and reappointment
Hospitals and health systems
Medical staff credentialing support
Specialty centers and ASCs
Facility credentialing files
Provider licensing
Keeping the licenses we verify current
Or return to the provider credentialing overview.
Free revenue audit
Find out what your practice is losing to denials.
Send us 90 days of remittance data and we will show you, line by line, which claims were underpaid, denied, or never worked, and what it would take to recover them. No cost, no obligation, and you keep the report either way.
No setup fee. No long-term contract. Pricing from 2.29% of monthly collections.