Delegated Credentialing: Getting Providers Seeing Patients Faster & Reimbursed Sooner

By Courtney Ivess, Director of Credentialing at Verifiable (Profile)

Healthcare APIs

One of the primary responsibilities of healthcare entities is to ensure providers enlisted to render services through that entity are who they say they are - possessing the required training, skills and licenses needed to perform function successfully. 

There are many moving parts to confirm these critical requisites - collectively referred to as credentialing. Delegating credentialing can be an effective solution for this labor-intensive and time-consuming operational requirement. 

Below is a breakdown of all you need to know about delegated credentialing and other information you need to decide the best course of action for your organization

What is Delegated Credentialing?

Delegating credentialing is an arrangement in which a healthcare entity authorizes another healthcare entity to credential its healthcare providers - such as when a preferred provider organization delegates the provider credentialing process to a hospital. Beyond credentialing verification, the delegated entity is responsible for reviewing providers' qualifications and executing credentialing decisions on behalf of the delegating entity.

The spectrum of specific data required to make credentialing decisions can include:

Ongoing Credentialing Obligations

Verifying data across the above spectrum can be burdensome even just once – but providers must be re-credentialed at least every two or three years at each facility and with each payer. This may include separate credentialing at each facility within the same organization.

Sounds like a lot (it is). The good news? The provider credentialing process is one your healthcare organization can outsource to another company. The two primary options for delegated credentialing include:

Understanding Regulators and Delegating Credentialing

There are several regulators involved with or have an interest in delegated credentialing:

Delegated Credentialing: An Increasingly Important Strategy

Demand for healthcare services is growing fast, and delegated credentialing can pay significant dividends in both time and money for healthcare organizations looking to keep pace with industry growth. Delegated credentialing can help reduce operational costs and support provider groups in having control and consistency in their revenue cycles. 

Benefits of Delegated Credentialing

There are four strategic benefits associated with leveraging an internal or external CVO to manage and centralize the provider credentialing process:

How Verifiable Can Help

Leveraging the right partnership for delegated credentialing can help simplify your organizations’ day-to-day operational processes and promote much smoother operations for all involved - employees, the facility and the patients in your care. This translates directly into valuable time and money savings. 

With Verifiable, your organization can directly access hundreds of primary sources to automate verifications in just seconds. Other benefits of this industry-leading compliance streamlining technology include:

If you have questions or are looking for help in any of these critical areas - be sure to get in touch and we’ll be glad to help!