Understand the benefits and challenges of delegated credentialing

Delegated credentialing can improve enrollment turnaround times for providers, decrease paperwork for practitioners and staff, and reduce lost or delayed revenue; however, there are also risks involved. Deborah Ormay, CPCS, CPMSM, a writer and speaker with more than 30 years of managed care credentialing experience, describes the benefits and challenges associated with delegated credentialing. 

Q: What are the benefits of delegated credentialing?

Ormay: For managed care organizations (MCO), advantages include reduced costs associated with the direct credentialing and recredentialing of their participating provider population, and improved provider satisfaction based on reduction of the “hassle factor” associated with becoming credentialed and enrolled in an MCO. For the delegated entity, the advantage is timelier enrollment of contracted providers into the MCO’s systems, allowing patients quicker access to their chosen providers, and a reduction in claims payment issues.

Q: What are the disadvantages or challenges of delegated credentialing?

Ormay: Accuracy of provider data in MCO systems and timely enrollment in MCO systems is a common challenge. MCOs have a template that delegated entities are to use when submitting their monthly updates of additions, terminations, and changes within their provider population. These templates vary from MCO to MCO, and the lack of uniformity can be a pain point for delegated entities. Technological capabilities of a delegated entity may not be at the same level as those of other delegated entities. For example, a delegate may not have the capacity to participate in video conferencing.

To read more about delegated credentialing and Ormay's experience, click here.