HealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsBe confident in your staff’s ability to reduce risk by providing compliance training that changes behavior.
View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsDeliver custom or industry designed product training directly to patient and resident care environments to reinforce proper use.
View All ProductsStop wasting money on RCM issues. Learn how to Provide your team with expert-led revenue cycle training to help them reduce denied claims, reimbursement mistakes, and more.
View All ProductsLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ProductsUnlocking the full potential of clinicians goes beyond aspiration – it’s a commitment we embody. Our competency development solutions help personalize learning for every clinician so you can confidently bridge the gap between theory and practice for your nurse residents while meeting the unique development needs of your seasoned clinician.
View All ProductsEnhance maternal & child nursing care with solutions focused on improving the quality of care for mothers, infants, and children.
View All ProductsAddress staffing challenges, standardize orientation and onboarding, and deliver an effective training program for your team to easily achieve and maintain certification with our critical, emergency, and acute care solutions.
View All ProductsWe understand the critical importance of earning and maintaining your patients' trust in the delivery of exceptional sedation and surgical outcomes. As a premier provider of healthcare education, we are committed to empowering you in promoting safer, more successful outcomes for each and every patient, without exception.
View All ProductsOur solutions are meticulously designed to cater to the diverse needs of patients, healthcare professionals, and organizations. Within this innovative framework, we have curated specialized subsets of solutions aimed at addressing the ever-evolving challenges faced by individuals dealing with illnesses or chronic conditions.
View All ProductsHealthcare workforce management is essential. We provide advanced scheduling solutions for organizations to solve issues such as nurse retention
View All ProductsTackle all the challenges of practitioner directory management within a health plan with a single solution tailored to your specific needs.
View All ProductsOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsFinally, a comprehensive resource to support collecting, storing, and sharing credentialing data with ease.
View All ProductsIntegrate with Epic to validate and add new providers directly to your provider master file.
View All ProductsMitigate risk and elevate your quality of care. Improving both clinical and business outcomes starts with a smarter, more integrated approach to regulatory training, continuing education and quality management.
Learn MoreOne of the things most people look for today, regardless of industry, is how to perform a task accurately and quickly. The need to be efficient is paramount, and when it comes to provider enrollment and credentialing, it’s essential. When done poorly, the process can be time-consuming and inefficient, resulting in revenue loss for busy healthcare providers. However, an approach to gaining success is delegated credentialing. In this blog post, we'll delve into what delegated credentialing is, its benefits for both the organization delegating and the organization being delegated to and how the process works.
Delegated credentialing is a process where a healthcare entity grants another healthcare entity the authority to credential its providers. For example, a preferred provider organization (PPO) may delegate credentialing responsibilities to a hospital or medical group. This goes beyond credentials verification, as the delegated entity is responsible for evaluating qualifications and making credentialing and appointment decisions on behalf of the delegating entity.
When organizations step into a delegated credentialing agreement, there must be a mutually agreed upon arrangement that outlines all the necessary obligations as they pertain to different regulatory bodies, like the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Centers for Medicare & Medicaid Services ( (CMS), and federal and state laws. Delegation agreements can be a separate agreement or an amendment to an existing parent contract/agreement.
When done properly, delegated credentialing can save organizations significant time, enabling patients to access care more quickly. The benefits vary based on the organization.
From a Health Plan's Perspective
From a Healthcare Organization's Perspective
A healthcare organization must have a robust 'in-house' credentialing process to participate in delegated credentialing. Ensuring this involves a comprehensive evaluation of the process.
The first step lies in ensuring the organization meets accreditation standards, which means the organization has a process in place that:
Now, every delegated contract will have organization-specific requirements, but standard contracts should include:
Once this has been done, the delegate will be authorized to complete credentialing for the delegating organization. As part of this agreement, the delegate will be required to share a provider roster with the delegating entity about once per month. This roster will then be used to either associate or disassociate a provider with an organization and provide high-level information on a provider, including their change of status, address, and billing information. When the delegating party receives an updated provider roster, any new provider listed can be considered "Participating" and, therefore, eligible for reimbursement.
Organizations should think carefully about what organization they partner with as a delegated credentialing entity. When considering this partnership, consider these criteria:
The NCQA permits delegating several activities, including credentialing, re-credentialing, case management, utilization management, disease management, and health promotion. However, certain activities, such as those involving member experience, privacy and confidentiality, and marketing information, cannot be delegated.
By embracing delegated credentialing, healthcare organizations can unlock a win-win solution for providers, plans, and ultimately, patients. Streamlined processes, quicker enrollment, and enhanced provider satisfaction make delegated credentialing the future of efficient and effective healthcare administration. Partnering with the right NCQA-accredited delegate empowers medical organizations to focus on what they do best – delivering high-quality care – while leaving credentialing in the hands of experienced experts.
Take the first step towards a faster, more efficient future for healthcare – find out how CredentialStream® can help with all your credentialing needs, including delegated credentialing. Arrange a demonstration with one of our experts today.
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceBe confident in your staff’s ability to reduce risk by providing compliance training that changes behavior.
View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsUtilize patient access solutions and advanced reimbursement solutions to manage clinical denials and improve your organization’s reimbursement strategy.
View All ReimbursementExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ProductsUnlocking the full potential of clinicians goes beyond aspiration – it’s a commitment we embody. Our competency development solutions help personalize learning for every clinician so you can confidently bridge the gap between theory and practice for your nurse residents while meeting the unique development needs of your seasoned clinician.
View All ProductsEnhance maternal & child nursing care with solutions focused on improving the quality of care for mothers, infants, and children.
View All ProductsAddress staffing challenges, standardize orientation and onboarding, and deliver an effective training program for your team to easily achieve and maintain certification with our critical, emergency, and acute care solutions.
View All ProductsWe understand the critical importance of earning and maintaining your patients' trust in the delivery of exceptional sedation and surgical outcomes. As a premier provider of healthcare education, we are committed to empowering you in promoting safer, more successful outcomes for each and every patient, without exception.
View All ProductsOur solutions are meticulously designed to cater to the diverse needs of patients, healthcare professionals, and organizations. Within this innovative framework, we have curated specialized subsets of solutions aimed at addressing the ever-evolving challenges faced by individuals dealing with illnesses or chronic conditions.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare workforce management is essential. We provide advanced scheduling solutions for organizations to solve issues such as nurse retention
View All ProductsComprehensive, industry-leading provider onboarding and credentialing software that validate health outcomes and support provider assessment.
View All CredentialingOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsIntegrate with Epic to validate and add new providers directly to your provider master file.
View All Products