Achieving delegation success

There are many factors that contribute to successful delegated credentialing for both the health and delegated entity to consider. Below are tips and recommendations for the health plan:

  • Review the delegation agreement thoroughly to ensure that credentialing activities can be performed as expected
  • Maintain a detailed list of requirements for each delegation agreement held with payers, highlighting the differences to ensure compliance 
  • Create a process for files that do not meet clean criteria (i.e., that have red flags) and communicate to the payers as appropriate
  • Inform health plans of any adverse issues with practitioners in a timely manner
  • Create a standard reporting template inclusive of all payer requirements to facilitate a consistent reporting process
  • Routinely audit files and the credentialing database to ensure accuracy of practitioner data
  • Review and prepare files in advance to facilitate audits
  • Build and maintain credibility by maintaining a compliant and timely credentialing process
  • Be accessible during health plan accreditation surveys

Source: Credentialing for Managed Care

Found in Categories: 
Credentialing, Provider Enrollment