Inside the Wild, Wild West of Ongoing License and Credential Verification

Good afternoon, everyone. Thank you for joining today. We’re really happy that you are in attendance. I’m Dale Clay, chief technology officer at ProviderTrust. Really happy that you’ve taken some time out of your day to join us for this webinar. And I’m particularly excited to be talking about this topic, something that’s very near and dear to my heart. So today, you’re gonna hear from, me and a couple of my colleagues on our data team. But before we get started, and dive into that content, I just wanted to go over a couple of housekeeping items. First thing, phone lines have been muted. We just wanna eliminate any background noises or distractions. However, if you do have any questions during the conversation, just type it into the chat, and we will do our best to address any of the questions along the way. I do want you to know that we are recording today’s conversation, and at the end of this, it’s gonna be distributed in a follow-up email. It’s gonna come from provider trust. If you have any questions, that didn’t get answered in the chat, you can just respond to that email, and we will do our best to answer those questions. So with that, we’re gonna get started and, dive into the wild wild west of license and credential verification. So first up, let’s just meet the crew. Like I said, I am Dale Clay, chief technology officer at ProviderTrust. I’ve been here for the better part of ten years and, personally have felt the pain of, license verification that isn’t done well and, took it upon myself to help us build a better version of it. So that’s a lot of what we’re gonna be able to talk about today. Deputy Jacob, you wanna give an introduction? Yes. Hello. I’m deputy Jacob Bell. I am the operations manager of data product operations. Internally, we refer to that as monitoring operations. What that means is we my team is in charge of delivering the mail. Right? The, to our clients, the license verification results, making sure that things are running smoothly. And if they don’t, we get in there and, quickly fix it. So, I have been here for almost two years and, just happy to see you and happy to talk to you about what we have to share today. And then we have Melissa Lapsley. Hey, everyone. I’m Melissa Lapsley, the senior credential data quality analyst here at ProviderTrust. Been here for a little over five years. In my role, I manage large scale data analysis and crosswalks. My role involves conducting license verifications, identifying product improvements, collaborating across teams, and just ultimately contributing operational expertise to shape new initiatives and solutions. Thanks, Melissa. Thanks, Jacob. The voice over here is that when it comes to license verification, this is the dream team. So, let me go over what we’re gonna cover today. Really, our goal is to take you, in a in a deep dive into our processes for how we do license and credential verification at scale. So it’s a little bit of a behinds behind the scenes look. We’re gonna start big, look at the macro, and then we’re going to, jump into, really the detail level, how what we do, impacts patients safely directly, make makes your job easier. We’re gonna look at credential analysis process and show you how, the close level of of detail that we give to our verifications really makes a difference, and then we’ll be able to, answer questions along the way. So that’s kinda where we’re headed. I wanted to start kind of with a a, some results from a survey that we had. Earlier this year, we conducted this survey of of executives at provider organizations, and we asked them about their license and credential verification hurdles. One of the primary themes that emerged was frequency of verification, so how often a license gets verified. Most of the respondents, verified their provider’s credentials on an annual basis, but almost all of them said that they would like to verify them more often. This is something that we have absolutely felt the impact of, and we’ve really taken it upon ourselves to build a license verification system that is able to verify licenses on a frequent basis. So what I wanted to talk about is is kinda give you a little bit of a sense of of what we’ve done so far. So today, we’re monitoring over ten million people and entities. A couple of million of those have licenses, and credentials that we are monitoring. That all equals, that all adds up to about forty three million license verifications that we are doing annually. When we’re talking about frequent verifications, when we’re talking about scale, this is something that we are very, very familiar with. When we set about to build a better license verification system, we knew that we would have to build it for scale, and so we we’ve done just that. One of the things that’s really interesting to me is just how diverse the license verification ecosystem is. We are integrated with, over six hundred boards, six hundred and thirty five at last check. So we have quite a bit of experience with the subtleties, the diversity, and the nuance that comes from all of these different boards all trying to, you know, tell us the same information. So what makes provider trust different? One of the things that we set out to do in addition to building a license verification system that could scale at high volumes, is that we wanted to give close attention to the data integrity and the quality of the results that were being passed, that we’re passing back to our clients. The something that I’ve said, a lot is that anyone can verify a license once. Right? You can go to the board. You can plug it in. But it really takes an intentional data strategy to do that millions and millions of times across the hundreds of sources that we were just talking about on an ongoing repeatable basis. What we’ve done is we, we’ve built a system that allows for, you know, the the ninety five percent of the cases that are just right down the middle, we will allow those to go through on an automated basis. But for the ones that need a closer review or that deviate from what we would expect, we pull it over. We take a look at it. We add our own interpretation and intelligence to it so that by the time it makes it back to our clients, it’s it’s in a format that allows them to make the best decisions for their patients, the best decisions for their workforce. So we’re we’re there to help connect the dots and to provide actionable results back to our clients. I I wanna give you an example of something that we’ve done. So a few years ago when COVID nineteen was was really just first, being introduced and all of our health care clients were having to respond to the unprecedented situation, we had to stand in the gap between some of our license boards and our clients. And so I wanna give you, just an example. This is an example screenshot from a license verification that we did from, Pennsylvania. And what I wanna draw your attention to is is the, the yellow bar at the top. Right? So this is this is saying in in response to COVID nineteen, the Pennsylvania Department of State has extended nurse expiration dates that would normally expire on April thirtieth of twenty twenty. They’re extending them to instead expire on July thirty first of twenty twenty, which is great. We saw this happen in a lot of different boards. It was an emergency measure. But what I want you to see is how on the on the actual verification result page, the expiration date still says April thirtieth. So this was this was happening all across the United States on almost all of the license verification primary source boards. So what we did is we designed a system that would take the the actions and the edicts that were, that were created by the different state governments, and we would interpret what we were actually, finding on the result page. So instead of just passing passing back April thirtieth twenty twenty and letting and making our clients do all of the interpretive, you know, jumping through of jumping through the hoops and mental gymnastics of trying to determine is this actually expired or is it not? We would do that interpretation on on the behalf of our clients so that what was being sent back was really representative of what was true, not just what was printed on the result page. And this is one of many examples that occurs. What feels like every month, we run into another example like this, not not nearly as widespread, as what happened with COVID nineteen, but this is an example of how we are we are standing in the gap between primary source and clients committed to providing what we consider, a highest level of quality. And so this is just one example. I’m gonna pass it over to Jacob, and he’s gonna talk about some other examples about how we think about ongoing monitoring, as a way to, apply preventative measures in our license verification. So, Jacob, take it away. Thank you, Dale. Yeah. So we’ve looked at, you know, the scale of our work and how, how provider trust approaches getting through the volume and and how we handle different data coming from the board. But I also wanna talk a little bit about why ongoing monitoring is so important to our clients and to us. We know at a regulatory level, you’re only required to verify a license at higher and then at expiration. What that could do is it could leave a gap of up to several years or eve or a year, several years where you have no idea if something has changed, you know, specifically talking about maybe disciplinary action. Ongoing monitoring means that we’re verifying your data once a month at the primary source, so you’ll know as soon as there’s a meaningful change. So monthly credential verification cadence helps us catch these issues like the, you know, the sanctions, the the disciplinary actions, adverse actions, things that wouldn’t be caught for some time if you’re just looking at things even every year if it’s a yearly expiration. For example, like, over a thirty day window, we return about sixty thousand on average disciplinary actions for our client base. That’s not, like, necessarily new disciplinary actions. It could be ongoing disciplinary actions that haven’t either cleared from the board or won’t clear, or certain sources leave them up there in perpetuity, even if, for example, the the time frame of that disciplinary action has expired. But, you know, there’s still indications, and we wanna return that to our client base. So, you know, sixty thousand over thirty days, we we think that’s important, and and I wanna get into a little bit about why. It’s because you could miss those if you’re only looking at higher and expirations. If you’re trying to find bad actors in your population by only monitoring federal OIG or state exclusion lists alone, you may go sometime without finding those. We’ve, done a little analysis on on some data, and we’ve found that there’s an average of about eighteen months between the time that somebody receives a a, you know, a sanction at the at the board or a a disciplinary action on the board and then when they show up on an OIG exclusion list. So eighteen months is a long time. A sanction or a board action or a disciplinary action doesn’t always mean you’re gonna be on the OIG exclusion list, but it does mean that we we wanna give our clients something to go look at, something to to look into and say, hey. We found something. I think it’s important that you know, obviously. And and our goal is to give as much adverse information that’s out there to you as soon as it’s available. So what that lets our clients do is, you know, make the right decision for the organization and the communities that you serve to make sure that you’re providing the safest health care. Excuse me for my voice. I’m a little bit scratchy today. There’s a lot of fraud, waste, and abuse out there that can lead to a credential suspension or ending up on an OIG or state exclusion list. I I wanted to just take a minute. You know, a lot of the time in compliance, we’re looking at the data and the the codes that show up for disciplinary action or, just somebody’s name showing up on a list. Just sometimes it’s good to step back and remember why, why we’re looking for these these, you know, bad actors, the perpetrators of fraud, waste, and abuse. So I have a couple of examples to consider, to to let us know, you know, why it’s an industry best practice and and critical to providing the best care. So, for example, we have a surgeon whose license to practice was restricted or acted against by the state board for false statements and applications for insurance, who then subsequently continue to make and complete appointments with patients afterward with medical expenses over a span of couple of months that were about a hundred thousand dollars. I have a GP with a revoked license and excluded for conspiracy to distribute and dispense controlled substances for not legitimate medical purposes and, you know, not in the usual course of the professional practice, and then distributed these thousands of prescriptions across state lines, to drug addicts, sometimes several states away. Have a dentist who created an unauthorized employee account to receive these controlled substances and then charge them back to their employer over the course of seven months. A family practice physician with multiple instances of failing to furnish patients’ medical records to a succeeding physician. And then when the state board, you know, legally requested more information, that physician also failed to furnish that information to the state board. Two more, an anesthesiologist suspended for repeated indications of chemical dependency while practicing, until that person demonstrates the ability to practice medicine with reasonable skill and safety and positive mental evaluation. And then finally, a pediatrician who was providing nonstandard care for a a childhood disease and then didn’t document why they were doing that, why they made that decision, and, why they kinda went off the path of the normal treatment for this. And, you know, the board took action on on these folks. And then, we’ll say an average of eighteen months later, they ended up on an exclusion list. So these are pretty scary stories. Right? And I even picked some tame ones. I didn’t wanna make this a doom cast and get get too dark. But needless to say, for the most part, it I would say disciplinary actions from the credential authorities move more quickly there. So there’s a wealth of critical information that could be missed if you’re just looking for state or OIG exclusion lists for a span of time in which more damage, more fraud, waste, and abuse could happen. So that’s why that monthly verification cadence is crucial. To talk about human intervention, I wanna bring in Melissa and let her tell us a little bit about that. Thank you, Jacob. Okay. So to build on Dale and Jacob’s point, our job isn’t just to verify your license. It’s to ensure you’re verifying the correct license. Now the data we receive often comes from multiple sources and in many different formats, which can lead to many inconsistencies. So automation is important, but it isn’t the only piece of the puzzle. So my role is to audit that data, identify what’s important, and understand the individual licensing boards and ensure accuracy before it gets back to our clients. So we don’t just take the information the client provides and hand it right back to them. We go deeper to identify issues and offer solutions to improve data quality. So this can involve understanding the client shorthand, deciphering codes without a glossary, manually verifying date large datasets to confirm the correct license issuers or the correct license types, or ensuring the license numbers are properly formatted to improve automation results. So, sometimes the client data we receive doesn’t include information like license issuer or license type. Because of our understanding of the license ecosystem and our commitment to data integrity, we really work diligently to manually find these pieces of information, allowing us to then fill in some of those missing pieces. So in this example, you’ll see our client only store the provider’s PII. So items like the provider’s name, place of birth, the license number. And I was then able to fill in those gaps by using data such as the provider’s facility location or acronyms associated with the license numbers, and then board information to give the client everything they needed to accurately crosswalk their licenses into our system. Now another thing we notice is that everyone stores data differently. There are different shorthands and different labels. And many times, we end up having to combine datasets from multiple different facilities in order to get a full picture of a client’s data. Now in order to crosswalk a client’s data to provider trust data, we may need to enhance or complete or map the data differently. So our goal is to get as as close as possible to the primary source so that our clients have the most accurate and up to date license information. So a computer just can’t do this. So because of our extensive knowledge of state boards and other primary sources, we’re able to take client data that is just disjointed or doesn’t match the primary source and still find the collect correct license information. We’re able to work through understanding and then recategorizing that information that our client gives us to then match what is actually at the primary source. Now in this example, the clients provided data across multiple different fields. We have them listed as, the issuer listed as the Alabama Board of Medical Examiners and also ABMS. And then we have the license type listed as physician MD and orthopedic surgery, pediatric orthopedic surgery. And then using the clients provided samples, I was able to determine that the correct issuer and type is the ABMS and orthopedic surgery specialty certificate. So using that information, we’re able to write an ETL script and accurately crosswalk all the data with those matching fields. So we’re not just changing the client data. We’re also auditing that data to ensure that we’re mapping an accurate representation of the licenses so that our systems can then speak to each other. Now every step in the process is really about making sure the data is reliable and then ready to be used effectively. Our goal is to be a true partner in helping our clients maintain accurate license records and to be used effectively. Now in addition, we also leverage our strong relationships with these licensing boards. So this allows us to flag issues not only with the licenses, but with the boards themselves. We notice a discrepancy like, expiration date mismatch, we’ll contact that board directly. So in some cases, we’ve actually helped the board themselves correct their own systems based on what we found. Now let’s see. I think Dale, I’m gonna pass it back over to you to wrap things up. Yeah. Thanks thanks, Melissa. There is an enormous amount of of work that is encapsulated within what you just described. I I think it’s really, really important, the the work that you just described. I appreciate you taking us into that detail. So I’m gonna land the plane here. What I hope you have learned here is is just a little bit about how we how we view the world and how we try to make our clients’ lives a bit easier and the patients that they serve, the outcomes for their patients a little bit better. Essentially, we’ve been at this for the better part of a decade. We’ve learned a few things. We’ve kind of compiled them into, this this short list of you know, if if you’re if you’re a current client of provider trust, we hope this is what you’re experiencing. If you’re just learning about license verification and you’re you’re shopping around like this, this is kind of the list that you want to carry around with you. The first thing that we think, you need is is a a qualified partner. You want them to do a few things for you. One, you wanna reduce the manual work. So instead of just passing back, the data as it’s, expressed on the board, there’s an interpret an an interpretation layer just like Melissa was talking about that’s really important to make sure that you’re getting actionable and, accurate data that doesn’t create a bunch of manual work for you to do. Second thing, making sure that the frequency of primary source verifications is adequate and sufficient. Going back to what Jacob was talking about, you know, monthly is is what allows you to really get to the information that you need to make better decisions, for your populations. Being able to respond to changing licensure actions more timely. Again, that’s that’s related to getting fresh results back from the primary source in a way that you can use it and respond to it, and making sure that your practitioners have all the required licenses and certifications for their role. We have this whole ecosystem of software that allows you to build requirements for each of your roles, each of your jobs, and we help, conduct all of the primary source verifications to make sure that those are up to date, accurate, and active. But, in addition to that, making sure that you’re paying attention to those board actions. Make sure that you’re notified, when those do pop up that you’re you’re we’re drawing your attention straight to that. A partner needs to be able to, bring that to your attention so that you can respond accurately. Any anything that allows you to do expiration tracking and management in real time, even if something can’t be primary source verified, making sure that you’re tracking when some something or credential is, expiring. Primary source screenshots for all of your verifications. This is something that we’ve done from day one. Anytime we go out and grab a, verification from primary source, we don’t just return the data. We return the screenshot so that if you’re if you’re having to sit down and look through the history, you can see the screenshots over time, what changed. You can put that in front of your auditors, and that just helps tell the story of how you’re staying compliant, and staying on top of your license verification process. And then lastly, this kind of goes into that, but being being able to, being able to pass audits and prove that you’re doing, what what you’re supposed to be doing and keeping your population, safe. This is really what we’ve we’ve learned over the past, number of years having done this, millions and millions of times. We hope it’s helpful for you. Again, thank you for taking some time to, spend spend a little bit of your day with us learning about, credential management, license verification. We hope it’s been helpful for you. If you have any questions that you did not get answered, in the chat, again, you’re gonna get an email with the link to this recording. Just respond to that email with any questions you’ve got, and we will be happy to answer them. And with that, we hope you have a good rest of the day. Thank you very much.