What We Do

Our CVO services meet and exceed NCQA Credentials Verification Organization standards. We perform thorough primary source verification for every provider in your network, ensuring accuracy, compliance, and audit-readiness.

• Primary source verification of education, training, licensure, and board certifications
• Ongoing monitoring of sanctions, exclusions, and disciplinary actions (OIG, SAM, NPDB)
• Credentialing file management with complete audit trails
• Re-credentialing cycle management (36-month compliance)
• Customized credentialing committee support and reporting
• Cloud-based digital file storage with role-based access controls

Navigating state licensing boards and payer enrollment processes can be time-consuming and complex. We manage the entire lifecycle — from initial applications through renewals — across all 50 states.

• Initial state medical license applications and documentation
• License renewal tracking and timely submission
• DEA and state-controlled substance registration
• Medicare and Medicaid provider enrollment (PECOS)
• Commercial payer credentialing and network participation
• CAQH profile creation, attestation, and maintenance

Our utilization management support helps organizations maintain quality care while controlling costs. We build and manage UM programs that satisfy NCQA accreditation requirements.

• Prior authorization workflow design and processing
• Concurrent and retrospective review coordination
• Clinical criteria development (aligned with MCG, InterQual)
• Appeals and grievance process management
• UM committee structure and documentation
• Turnaround time tracking and compliance reporting

Achieving NCQA accreditation demonstrates your commitment to quality. Our consultants guide you through every phase — from initial gap analysis to the final survey — ensuring you meet or exceed all applicable standards.

• Comprehensive gap analysis against current NCQA standards
• Policy and procedure development tailored to your organization
• Staff training on NCQA requirements and best practices
• Mock surveys with detailed remediation plans
• Virtual review preparation (screen-sharing walkthroughs, system demos)
• Ongoing compliance monitoring post-accreditation