Delegated Credentialing
Delegated Credentialing Services for Provider Organizations
We build, run, and repair the operational layer behind delegated credentialing agreements — NCQA-aligned primary source verification, committee-ready files, monthly rosters, re-credentialing cycles, and audit readiness.
Delegation turns credentialing from a queue into a calendar
Without delegation, every new practitioner enters each plan's individual application queue and waits. With delegation, the same practitioner is credentialed by your committee and added on your next roster submission. For an organization hiring in cohorts, that difference is measured in months of billable time per provider, repeated across every hire.
The trade-off is accountability. A delegated agreement makes your organization responsible for verification quality, file integrity, monitoring, re-credentialing timeliness, and roster accuracy — and the plan audits all of it. Most programs do not fail because the concept is hard; they fail because the cadence slips and nobody notices until the annual audit produces a corrective action plan.
That cadence is what we own. We work inside your existing credentialing system of record, alongside your credentialing committee and medical director, and we keep the file, roster, monitoring, and calendar work at audit standard continuously rather than in a scramble before review.
What we run inside a delegated program
Policy set and program design
Credentialing and re-credentialing policies, delegation matrices, and committee procedures written to align with NCQA standards and the specific language of each plan's delegation agreement.
Primary source verification
License, DEA, CDS, board certification, education, training, work history, malpractice history, OIG/SAM/exclusion, and NPDB verification performed and documented inside allowable time windows.
Committee-ready files
File packets assembled for credentialing committee review with clean flags, gap explanations, and everything an auditor pulls a sample to check.
Monthly roster operations
Roster builds, adds, terms, demographic and location changes, and reconciliation against plan-confirmed data each cycle.
Re-credentialing and monitoring
36-month cycles tracked per practitioner and per plan, plus continuous monitoring of sanctions, exclusions, and expirables on a rolling calendar.
Audit preparation and remediation
Pre-delegation and annual audit readiness, sample file review, and corrective action plan response when findings have already been issued.
The path to a delegated agreement
1. Readiness assessment
Gap analysis against NCQA-aligned standards and the plan's delegation requirements: policies, committee structure, verification process, file quality, monitoring.
2. Program build
Policy set, delegation matrix, committee procedures, verification workflow, monitoring schedule, and file templates put in place inside your system of record.
3. Pre-delegation audit
Sample files rebuilt to standard, mock audit run, findings closed before the plan reviews. We prepare the packet and sit in the process with you.
4. Ongoing operations
Monthly rosters and reconciliation, continuous monitoring, re-credentialing cycles, and annual audit readiness maintained as routine work.
Delegated credentialing FAQs
What is delegated credentialing?
Delegated credentialing is an arrangement in which a health plan formally delegates the credentialing and re-credentialing of practitioners to a provider organization. The organization performs primary source verification, maintains credentialing files, and submits a roster of approved practitioners; the plan retains oversight and audit rights. Practically, it means providers can be added to a panel on your roster cycle rather than waiting through the plan's individual application queue.
Why do large groups pursue delegation?
Speed and control. Under a delegated agreement, a new hire is typically effective on the next roster submission rather than 90 to 180 days later, which converts directly into billable start dates. Organizations with high hiring volume, multiple entities, or several states usually reach the point where individual applications cannot keep pace with onboarding.
What does a plan require before it will delegate?
A written credentialing policy set aligned to NCQA standards, a functioning credentialing committee with a medical director, documented primary source verification processes, file retention and confidentiality controls, a defined re-credentialing cycle (generally every 36 months), ongoing monitoring of sanctions and exclusions, and a pre-delegation audit of a sample of files.
What does Credify Health do in a delegated program?
We build and maintain the operational layer: credentialing policies and procedures, primary source verification to NCQA-aligned standards, committee-ready file packets, monthly roster builds with adds and terms, ongoing monitoring (OIG, SAM, license, board, malpractice, DEA, CDS), re-credentialing calendars, and pre-delegation and annual audit preparation. We do not replace your credentialing committee or medical director — the credentialing decision stays with them.
What causes delegated agreements to fail an audit?
The recurring findings are the same: verification documents outside the allowable time window, missing attestation or gap-in-work-history explanations, re-credentialing performed late, roster and plan records out of sync, ongoing monitoring documented inconsistently, and committee minutes that do not evidence the decision for each file reviewed.
Can you help us prepare for delegation from scratch?
Yes. We scope the gap between your current process and what plans require, write or revise the policy set, rebuild files to audit standard, set up the verification and monitoring cadence, and prepare the sample files for the pre-delegation audit. We also handle remediation when an existing delegated agreement has received audit findings or a corrective action plan.
Do you support roster reconciliation with the plan?
Every cycle. Roster drift — where your roster and the plan's records diverge — is the single most expensive delegated-credentialing failure, because claims deny for practitioners who are contractually in-network. We reconcile against plan-confirmed data monthly, not annually.
Credify Health provides operational, credentialing, enrollment, licensing workflow, and payer strategy support. Legal, tax, and clinical matters should be reviewed by the appropriate licensed professionals.
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Preparing for delegation — or cleaning up after an audit?
Tell us your provider count, plans, and where the program stands today. We'll come back with a readiness gap list and a scoped path to a maintained delegated program.