Adapt your existing processes for a delegated credentialing partnership

One of the most important steps in readying internal processes for a new delegated credentialing arrangement is ensuring all employees involved in credentialing and payer enrollment understand the rationale behind the new requirements. If managers are the only ones in the know, the staff members who are actually processing the files may overlook the new expectations and continue doing things the way they have always been done.

Before explaining all of the changes to their team, upper management and other implicated departments (e.g., finance, those involved in managing the delegated agreements) should compare their current processes to the relevant NCQA or URAC standards. Next, they should determine what changes are necessary to meet the new requirements.

Consider developing a cheat sheet that all employees can reference until they get into the habit of performing the additional tasks. For example, to adhere to NCQA requirements, initial and date verifications and documents to prove that they were reviewed no more than 180 days before the corresponding credentials committee meeting. Such simple tasks become routine with practice, but learning them in the first place can take time and energy.

When developing new processes, managers must avoid creating duplicative work for their team. If your department already completes part of a task required for a new delegated arrangement, update the existing approach as necessary to comply with both sets of expectations at once (e.g., NCQA requirements for delegated credentialing and Joint Commission standards for traditional credentialing). Always ensure you’re meeting the strictest set of standards.