What is Delegated Credentialing in the U.S. Healthcare?

Patient safety is of the utmost importance in any medical facility. To promote a safety-oriented approach in any medical facility, authorities have introduced a credentialing process that scrutinizes healthcare providers according to a given set of eligibility requirements.

This process ensures that any healthcare provider operating in any medical facility is capable enough to deliver the best care to patients keeping all their vulnerabilities and peculiarities in mind.

Sometimes, a hospital’s staff service department looks after the credentialing procedures, and sometimes it outsources it to a third-party provider that looks after it.

This third party can sometimes be a medical billing company or any other medical facility. A medical billing company can look after this task more efficiently and promptly as it will only focus on your job and customize your needs.

However, just knowing what delegated credentialing is, is not enough. Delegated credentialing has many benefits and a whole set of steps according to which it works. This place is a one-stop solution if you’re eager to find out tits and bits of delegated credentialing.

Let’s get started!

What is Delegated Credentialing?

Delegated credentialing is the process through which one healthcare organization provides another organization the authority to accredit its practitioners.

When a medical facility (suppose X) delegates credentialing responsibilities to another organization (e.g., a hospital, practice, or billing company), that organization is responsible for evaluating the practitioners’ qualifications and making its own credentialing decisions on X’s behalf.

For instance, a billing company like Clinicast provides delegated credentialing efficiently. It is integrated-friendly, and the powerful API provided by Clinicast makes it easy to incorporate into your company’s preexisting infrastructure and processes. In addition, their solution may deliver verified, formatted provider data for use in reporting and robotic process automation.

Clinicast’s staff of credentialing professionals can assist your organization in developing policies and processes that are NCQA-compliant, establishing a credentialing committee, and securing delegated credentialing contracts.

Requirements for Delegated Credentialing

equirements for Delegated Credentialing

Healthcare providers, including licensed independent healthcare professionals, facilities, and other organizational healthcare provider facilities, must be credentialed and re-credentialed per standards, rules, and procedures maintained by a delegated authority.

Credentialing delegation may be handled either independently via a Delegation Credentialing Agreement or centrally through a Delegation Grid in the capitation contract.

The delegate is responsible for keeping a detailed copy of its credentialing program that details the following actions in a manner acceptable to the Credentialing Body.

Below are some rules a delegate must follow to maintain successful credentialing.


Unless required by law or with the health care provider’s express consent, delegates are not permitted to disclose any details related to the medical facility’s credentialing or re-credentialing.

The First Step in the Credentialing Procedure

When a medical organization is in charge of credentialing, candidates must follow their application procedure and submit the company’s application form.

The Oversight of Delegation

It is a must to do an initial evaluation to determine whether or not the delegate meets the criteria for credential delegation. Then, it is necessary to evaluate the delegate annually to ensure it’s keeping to the rules. This entails meeting NCQA criteria and federal, state, and local mandates.

Strategies for Progressing

There may be a need for an action plan to foster compliance from delegates. Monitoring will continue if the target date for compliance is not met. If delegates continue not to meet your credentialing requirements, you may terminate their authority to perform delegated tasks.

Benefits of Delegated Credentialing

Reimbursement from payers may be expected more quickly if the time it takes to join a network is shortened. Practitioner and client experience may help both rises with the introduction of delegated credentialing.

We recognize that the needs of each practice for certification services will vary. That’s why our management and supervision services, new hire packages, and enrollment plans are all tailored to your specific needs. Some of Delegated Credentialing’s most noticeable features and advantages are listed below.

Expediting the Processes of Registration and Reimbursement

The time required for an insurance provider to decide whether or not to accept the physician on its panel and offer a start date for enrollment is shortened when delegated credentialing is used. Providers can start invoicing and being paid sooner if the effective dates and system engagement can be accelerated.

Effectively Enlisting Payers in a Timelier Manner

The administrative load of manually processing dozens of provider requests is lightened with delegated credentialing. Delegated credentialing also facilitates tracking and verification operations. A delegated relationship may improve productivity even when a hospital and a payer use the exact solutions.

Improved Access to Records

The delegation of credentialing responsibilities gives businesses a greater say over how their networks are presented to consumers and insurers. Rostering is a simple and effective way to manage the frequent changes in demographics and network participation necessary to maintain accurate provider data and directory compliance.

Increased Revenue

Healthcare givers could see more patients if they spent less time on paperwork. A rise in the number of patients a business sees each year is a way to boost its bottom line and be paid for its services.

Happy Patients

It may take a long time to get your credentials in order the first time around. Delegated credentialing allows for streamlined processes, which speeds up the onboarding of new doctors, cuts down on scheduling delays, and boosts patient satisfaction.


By enlisting the assistance of a reliable delegated credentialing provider like Clinicast, your company will be able to streamline its day-to-day procedures, benefiting not only the staff but also the facility and the patients under their care. In significant financial terms, this is quite advantageous. By connecting to hundreds of primary sources with Clinicast, your firm may quickly and efficiently execute recruiting.

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