PSV: what the credentialing verifier independently confirms

What PSV actually verifies

Primary source verification means a credentialing reviewer contacts the actual issuing authority behind each fact on your application, rather than accepting your written statement of it. That means your state license board directly, not your license number; your medical or training program directly, not your CV's description of it; and the National Practitioner Data Bank directly, not your own account of your claims and disciplinary history.

The full list a payer typically runs includes your active license status and any restrictions, DEA registration where relevant, board certification, education and residency or training completion, a set number of years of work history, malpractice claims history, and hospital privileges if you hold any — each checked against the entity that actually issued or holds it, not against your CAQH entry describing it.

The distinction matters because CAQH itself doesn't verify anything you enter 1Ref 1CAQH (2026).CAQH.That CAQH's profile is self-reported and not independently verified by CAQH itself, which is why a separate PSV process exists.. It's a self-reported repository — the accuracy is on you, and PSV is the separate, independent process that checks whether what you reported is actually true.

Why plans all check the same things, on the same clock

Most health plans that credential through CAQH follow NCQA's credentialing standards, which specify primary-source verification of licensure, an NPDB query, and a defined verification window before a committee can rely on the results 2Ref 2National Committee for Quality Assurance (2026).Credentialing — NCQA.That NCQA's credentialing standards define the PSV framework, the NPDB query requirement, the 180-day verification aging window, and how delegated credentialing and CVOs fit that framework.. That's why the list of what gets checked looks nearly identical from payer to payer — they're largely working from the same external framework, not independently deciding what matters.

This is also why the process is slower for a solo practice than a large group with a dedicated credentialing coordinator can make it look — verification runs through licensing boards, prior employers, and training programs that respond on their own timeline, not the payer's. A solo clinician who understands the difference between credentialing, enrollment, and contracting going in tends to plan for that timeline better than one expecting a single approval on a single date.

The two federal exclusion screens: OIG's LEIE and SAM.gov

PSV includes checking whether you appear on either of two federal exclusion lists: the HHS Office of Inspector General's List of Excluded Individuals/Entities 3Ref 3HHS Office of Inspector General (2026).Exclusions Program.That OIG's exclusions program bars federal health program payment for an excluded individual's services, and that the LEIE is the public database checked., and the General Services Administration's SAM.gov exclusion records 4Ref 4U.S. General Services Administration (2026).SAM.gov.That SAM.gov is the second federal exclusion/debarment database credentialing-grade screening commonly checks alongside the OIG LEIE.. An excluded individual or entity cannot be paid by a federal health program for services rendered 3Ref 3HHS Office of Inspector General (2026).Exclusions Program.That OIG's exclusions program bars federal health program payment for an excluded individual's services, and that the LEIE is the public database checked., which is why every credentialing process — not just Medicare's own — screens against both.

OIG's exclusions program bars payment for items or services furnished by an excluded person under any federal health program, and its public database, the LEIE, is the standard way to check 3Ref 3HHS Office of Inspector General (2026).Exclusions Program.That OIG's exclusions program bars federal health program payment for an excluded individual's services, and that the LEIE is the public database checked.. SAM.gov serves a similar purpose from the federal procurement and debarment side, and credentialing-grade screening commonly checks both together rather than treating either as sufficient on its own.

The practical point: screen yourself against both databases before you apply, and again periodically afterward — the obligation to avoid billing for an excluded person's services extends to anyone you hire, not just to your own status.

The NPDB query — check it before they do

Every credentialing committee running PSV queries the National Practitioner Data Bank directly, which independently holds malpractice payments and adverse licensure or privilege actions tied to your name 5Ref 5Health Resources and Services Administration (2026).National Practitioner Data Bank.That credentialing committees query the NPDB directly for malpractice payments and adverse licensure/privilege actions.. You can request the same query yourself, called a self-query, and see precisely what a credentialing committee is going to see before you submit anything 6Ref 6Health Resources and Services Administration (2026).NPDB Self-Query.That a practitioner can self-query the NPDB and see exactly what a credentialing committee will see before submitting an application..

There's real value in doing this before you apply anywhere new: if the record shows something you'd forgotten, disclosed differently elsewhere, or believe is inaccurate, you find out on your own timeline rather than mid-application, when a discrepancy discovered by someone else reads worse than the same discrepancy you disclosed and explained upfront. Attestation integrity — the standard that what you certify has to match what verification actually finds — is easier to meet when you've already seen what verification will find.

Why verification results have a shelf life

NCQA's standards treat a completed verification as good for a limited window before it's considered stale — 180 days from the date it was obtained — after which a committee has to re-verify rather than rely on the earlier result 2Ref 2National Committee for Quality Assurance (2026).Credentialing — NCQA.That NCQA's credentialing standards define the PSV framework, the NPDB query requirement, the 180-day verification aging window, and how delegated credentialing and CVOs fit that framework.. That's part of why an application that drags on for unrelated reasons can suddenly need a re-check of something that was already confirmed months earlier.

This is one of the more counterintuitive parts of a long credentialing process: a solo clinician can feel like the process restarted for no reason, when in fact the calendar itself is the reason. Keep your own copies of when each piece of documentation was verified or submitted, since a payer's request to resend something you already provided is often the aging window doing its job, not a lost file.

CVOs and delegated credentialing: who's actually making the calls

A payer doesn't always run PSV itself — many contract the work out to a credentials verification organization, or CVO, which performs the actual license board calls, NPDB queries, and exclusion checks on the payer's behalf, then reports results back against the same NCQA standards the payer would otherwise apply directly 2Ref 2National Committee for Quality Assurance (2026).Credentialing — NCQA.That NCQA's credentialing standards define the PSV framework, the NPDB query requirement, the 180-day verification aging window, and how delegated credentialing and CVOs fit that framework.. A larger group practice may also run delegated credentialing, verifying its own clinicians in-house under an agreement that a payer audits rather than duplicates.

As a solo practitioner without a group behind you, you're almost always going through direct or CVO-mediated verification rather than a delegated arrangement — that path is more relevant to group practices and hospital systems large enough to run their own verification unit. Knowing the difference mainly matters for understanding why a colleague at a large group described a completely different, faster credentialing experience: they may be moving through a delegated process your solo practice isn't structured to use.

Some credentialing bodies also accept a state-mandated application in place of, or alongside, CAQH — check whether your state requires one, since a state-mandated application follows its own separate verification requirements that CAQH's process doesn't automatically satisfy.