Introduction

The Nuts and Bolts of Delegated Credentialing – A “How To” On Implementing/Improving a Payor Enrollment Program

Hospitals, physician group practices, and other entities routinely seek methods to create efficiencies in getting individual practitioners enrolled with health plans. Delegated credentialing (i.e., credentialing by health care organizations on behalf of health plans) is one method that organizations can use. After all, many health care organizations have been credentialing practitioners in one form or another for years and are experts at it. However, credentialing for payor enrollment purposes has a few unique aspects that must be considered.

This webinar will address these aspects and provide a background on delegated credentialing, including the basics of implementing and improving a payor enrollment program. We will also focus on the regulatory and accreditation requirements (including the changes to the NCQA standards effective July 1, 2025) with which organizations must comply and provide recommendations for negotiating delegated credentialing agreements with health plans (such as contractual provisions that are non-negotiable!). Finally, we will cover best practices for credentialing practitioners for payor enrollment (e.g., using threshold eligibility criteria because it works just as well for payor enrollment as it does for medical staff credentialing).