Delegated Credentialing: Enabling providers to give faster care & get quicker reimbursements

Healthcare providers must be properly licensed to render care to people under their designations. Healthcare organizations must make sure that their staff has the needed skills, licenses & training.

This is done through a collective process called “credentialing”. Delegated credentialing is the most effective type for high-volume, time-taking operational requirements. Let’s see now in brief about delegated credentialing.

What is Delegated Credentialing?

It is a process between two healthcare entities in which one will assign the task of credentialing its providers to the other. Like when an interested healthcare entity delegates the task of the provider credentialing to a hospital. 

The delegated hospital handles tasks beyond credentialing verification. Such tasks include reviewing provider qualifications and carrying out credentialing decisions for the delegating entity.

Data essential for making Credentialing Decisions

• DEA registration
• Board certification/specialty information
• Education
• State license
• CDS (Controlled Dangerous Substance) certification
• Work history
• Disclosure questions
• Professional liability claims settlement history
• Malpractice history
• Sanctions & exclusions
• Attestation
• Hospital/facility affiliations

Delegated Credentialing Partnerships

Credentialing process can be very burdensome. Re-credentialing is also necessary for providers at least every two to three years with lots of inside complexities. But this process can be turned into a less-bothersome one by outsourcing or partnering with a credentialing company. The two primary options for delegated credentialing are;

1. Partnering with an external Credentials Verification Organization (CVO)

Special business groups that do primary source verifications for healthcare organizations.

2. Set up an internal CVO 

An office set by healthcare organizations to do primary source verifications for all healthcare providers across facilities.

RELATED: An Ultimate Guide To Provider Credentialing

Benefits of Delegated Credentialing

The benefits of using an internal or external CVO to manage the provider credential process are;

1. More time for medical staff

Credentialing is an added burden for providers along with the medical procedures they conduct. Setting up of doing a centralized credentialing will optimize the process. It thus gives extra time for providers and reduces unnecessary draining of energy.

2. Reduced time for payer enrollment

Delegating credentialing process will reduce the tie taken for enrolling a provider with a health plan. Without this, payers can take up to 4 to 5 months to credential a provider. Delegating can reduce this time to 1 to 1.5 months.

3. More revenue

Delegating the credentialing process reduces the number of paperwork providers handle. This saves their time so that they can concentrate more on their patients. An increase in patient encounters will increase organizational revenue and reimbursements.

4. Increased patient satisfaction

Delegated credentialing centralizes the entire process. This will help providers to concentrate more on patients and in turn, the patient onboarding and satisfaction level will rise.

Delegating Credentialing and Regulations

Centers for Medicare and Medicaid Services (CMS)

• It is a part of the U.S. Department of Health and Human Services (HHS), which administers Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and portions of the Affordable Care Act (ACA). 
• Healthcare entities that come under these Federal health programs and planning for delegated credentialing must know CMS demands extra that’s beyond the NCQA’s guidelines.

National Committee for Quality Assurance (NCQA)

• The goal of NCQA is to achieve improvements across the healthcare delivery system. 
• These guidelines lay the basis of delegated contracts often. That means entities need to go through their standards and requirements.

Local State governments

• Some local governments have their own set of requirements for the credentialing process.
• This includes mandatory applications, the use of a centralized organization to carry out the primary source verification, and sometimes specific turnaround times for the process.

Final thoughts

Provider credentialing doesn’t have to be a daunting process. With the help of the right tools, you can quickly and easily complete all the required essential data and approvals without any delays. Vozo revenue cycle management will help speed-up reimbursements. It provides new opportunities for efficient provider credentialing.

Whether you need help with physician credentialing or your RCM process, our experts are available 24/7 to help you to improve your practice workflow.

“Provide faster care & speed-up reimbursements with delegated credentialing”