Provider Data Management / Credentialing Verification Organization

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New Provider Data Management and Credentialing Verification Organization

A new solution to align North Carolina’s credentialing process with the National Committee for Quality Assurance Standards

The North Carolina Department of Health and Human Services has awarded a contract to Optum to implement the new Provider Data Management / Credentialing Verification (PDM/CVO) solution.

The new Provider Data Management / Credentialing Verification Organization (PDM/CVO) is a timesaving, cost-effective and scalable solution that consolidates provider data management and furnishes a centralized solution to coordinate enrollment, credentialing and ongoing data maintenance among the payers as a multi-payer system. 

The PDM component will have the capability to manage data intake and maintenance throughout the provider lifecycle, and the CVO component will perform credentialing on behalf of NCDHHS. In addition, this solution will:

  • Improve the user experience by eliminating redundant data entry across multiple plans, simplifying registration for multi-payer providers, enhancing security controls and providing real-time assistance. 
  • Address NC Medicaid program needs by reducing provider administrative burden in NC Medicaid Managed Care and NC Medicaid Direct and upgrading data architecture and modularity.
  • Align with Centers for Medicare & Medicaid Services (CMS) Standards and Conditions to support seamless coordination, integration and interoperability.

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