Delegated Credentialing

A tool that should be in the arsenals of both provider and payer organizations

It just makes sense to move to this more efficient way of getting providers into network faster. It means that providers can start seeing patients sooner, provider organizations see revenue sooner, and payer organizations can streamline their provider network growth in order to attract more members.

Delegated Credentialing by the Numbers

$950B

Annual administrative spend in the US healthcare system

$5,809

New revenue per provider, per day, missed while waiting the industry average for credentialing to be completed.

120-160 days

The industry average for a payer organization to credential a new provider

$2 Billion

The amount health plans spend annually juggling systems, requirements and vendors and face steep fines and regulatory scrutiny for inaccuracies in the data

$2.7 Billion

The amount physician practices spend annually responding to a near continuous stream of inconsistent requests to update and verify provider directories

Organization types that can delegate

  • Health Plans (United, Cigna, Aetna, Blue Cross Blue Shield Plans)
  • Preferred Provider Organizations (PPO)
  • Accountable Care Organizations (ACO’s)
  • Specialty Provider Networks (Dental, Vision)
  • Independent Physician Associations (IPA’s)

Organizations that credentialing can be delegated to

  • Provider Groups (single or multi-speciality, multiple or single location)
  • Independent Physician Associations (IPA’s)
  • Hospitals & Hospital Systems
  • Specialty Provider Networks (Dental, Vision)
  • Credentials Verification Organizations

Steps to Establish Delegated Credentialing

01

Select a Delegated Entity
(CVO or In-House)

Healthcare organizations choose a trusted entity, such as another healthcare organization or a credentials verification organization (CVO), to handle the credentialing process, if they are not certified to manage delegated credentialing internally.

02

Enter a Delegation Agreement

A formal agreement is established between the healthcare organization and the delegated entity, outlining responsibilities, expectations, and compliance requirements.

03

Go Through Primary Source Verification

Healthcare organizations choose a trusted entity, such as another healthcare organThe delegated entity verifies practitioner qualifications by directly contacting authoritative sources, confirming education, licensing, and more.ization or a credentials verification organization (CVO), to handle the credentialing process, if they are not certified to manage delegated credentialing internally.

04

Evaluation and Approval

The delegated entity evaluates qualifications, makes credentialing decisions, and communicates them to the healthcare organization.

The Verifiable Difference

With nearly 1 million providers managed on the Verifiable platform, we are bringing automation that scales with even the largest provider networks.

2 mil

Unique PSVs per month

15 sec

Verification turnaround time

3200+

Automated verification success rate

25 min

Average credentialing packet creation time
- Including PSV

Want to learn more about how delegated credentialing can benefit your organization? Access our free guide on the subject.