PMG Credentialing, Inc. Achieves NCQA Accreditation: A New Standard in Credentialing Services
In September 2024, PMG Credentialing obtained Accreditation in Credentialing and Re- Credentialing through the National Committee for Quality Assurance (NCQA).
This prestigious recognition reflects our commitment to excellence in the credentialing and recredentialing processes. This achievement signifies that we meet the highest industry standards for verifying the qualifications and competencies of healthcare providers, ensuring that patients receive care from fully qualified professionals.
NCQA’s President, Margaret E. O’Kane, quoted “Achieving NCQA Credentialing Accreditation demonstrates that PMG Credentialing, Inc. has the systems, process and personnel in place to conduct credentialing in accordance with the strictest quality standards.”
What This Means for PMG Credentialing Clients
When contracting for credentialing services with PMG, our clients will be able to receive the following benefits working with an NCQA accredited organization:
1. Reliability and Trust: NCQA Accreditation ensures that PMG Credentialing follows the industry’s best practices, providing clients with a reliable partner they can trust to handle their credentialing needs with precision and efficiency. NCQA requires credentialing files be reviewed as a part of receiving accreditation, so our clients can have confidence in knowing that their practitioners are being credentialed properly.
2. Adherence to Ongoing Monitoring: NCQA requires that ongoing monitoring takes place on a continuous basis for all credentialed practitioners. Following this standard provides peace of mind to our clients that PMG is reviewing any potential red flags that may occur throughout a practitioners employment.
3. Communication to Clients: As an accredited organization, PMG is required to have documented communication and feedback from clients. This standard applies to all aspects of partnering with us including: our contract agreement with your health center, the delivery of your practitioner credentialing files, regularly scheduled reporting, timely notifications to your practitioners and internal administration throughout the credentialing process, and ongoing monitoring alerts discovered by PMG.
4. File Processing: NCQA requires credentialing be completed within 120 days from when a practitioner submits their application. While PMG policy is 90 days (and our average file completion being less than 30 days) this standard ensures that all credentialing is completed in an appropriate timeframe.
5. Data Security: NCQA has numerous standards that must be followed to ensure practitioner information is kept secure, that there are mechanisms for data back-up, security permissions to only allow appropriate staff to access and update practitioner information and required documentation of any modifications made to a practitioner’s information. These standards hold PMG accountable to by having integrity and confidentiality with the data we are responsible for.
6. Payer Delegation: This accreditation also allows PMG to leverage our status when engaging with health plans, providing the potential to secure delegation agreements on your behalf. This can significantly reduce provider enrollment processing times for your
organization.
The Difference Between Credentialing Accreditation and CVO Certification
PMG Credentialing, Inc. is a Credentialing Verification Organization (CVO) and while the large majority of CVO’s choose to obtain certification, we made the decision to elevate our company further in achieving accreditation status.
NCQA defines CVO Certification as: Certification evaluates the operations of organizations that verify practitioner credentials. Verification is accomplished through the primary source, through a recognized source or through a contracted agent of the primary source.
NCQA defines Credentialing Accreditation as: Accreditation evaluates the operations of organizations providing full-scope credentialing services, which includes verifying practitioner credentials, recredentialing and credentialing committee review of practitioners.
While both recognitions are notable and share some of the same standards regarding policies, ongoing monitoring, and verification of credentials, there are several differences between them:
1. Accredited organizations have additional standards to meet that CVO certified organizations do not. This includes framework for working with clients, interventions, having a credentialing committee, re-credentialing cycle file processing and timeline, actions against practitioners, and ongoing assessment of providers.
2. An organization that is NCQA Accredited is better positioned to receive a delegation agreement with a health plan faster, which means their providers will get enrolled faster. Plans that delegate credentialing activities to NCQA-Accredited organizations can receiveautomatic credit on their Accreditation Survey.
Source - https://www.ncqa.org/wp-content/uploads/NCQA-Credentialing-eBook-2023-WEB.pdf
