Primary Source Verification

The following items are primary source verified by CCPA’s credentials verification organization.

Credentialing Item	Source of Verification	Cred	Recred
Current State License to Practice in Illinois and Controlled Substance	IDPR	X	X
Current License to Practice in Other States	State Licensing Board	X	X
DEA Registration	Copy of DEA	X	X
Denial, Suspension, Limitation of DEA	NPDB, Letter to DEA, NTIS	X	X
Medical School or Professional School	ABMS (CertiFACTS), Letter from School, AMA Profile, ECFMG	X
Residencies Post Medical School Graduation (Only if not board certified and this is the highest level of training)	ABMS (CertiFACTS), Letter from Institution, AMA Profile, ECFMG	X
Fellowships Post Medical School Graduation (Only if not board certified and this is the highest level of training)	ABMS (CertiFACTS), Letter from Institution, AMA Profile, ECFMG	X
Board Certification All Specialty Board Certification	ABMS (CertiFACTS), AMA Profile, Letter from Board	X	X
Board Certification All Specialty Board Certification – No Expiration Date	ABMS (CertiFACTS), AMA Profile, Letter from Board	X	X
Work History	Completed Work History Section of Application and/or CV	X	X
Sanctions Against Licensure	NPDB, Licensing Board	X	X

Verification of Credentials

CCPA delegates its primary source verification (PSV) of physicians’ information to a Credentials Verification Organization (CVO). NCQA provides CCPA with guidelines and standards on the process used to choosing and using a CVO. CCPA only delegates the PSV portion of the credentialing process to the CVO but maintains authority over final decisions of approving membership. To guarantee that NCQA standards are followed between CCPA and the external organization, CCPA uses a CVO that is NCQA certified.

Ongoing Monitoring and Interventions

CCPA delegates the collecting and reviewing of Medicare and Medicaid sanctions to the CVO.

On a monthly basis, the CVO monitors the following reports:

The current Medicare and Medicaid Sanctions via the Office of Inspector General (OIG) and Excluded Parties List System (EPLS) sanction reports.
The most current report for Medicaid Sanctions from the Illinois Department of Professional Regulation website.

On the monthly report to CCPA, the CVO will indicate whether a CCPA member was flagged by any of the above agencies/websites. CCPA staff will report results to its Credentialing Committee at the following meeting, and details will be recorded in the meeting minutes. If a sanction is reported against a CCPA physician, the CCPA staff shall then bring the issue to the attention of the Committee for processing under the CCPA Notice of Hearing Policy and Procedures.