Credentialing Corner

# What is Delegated Credentialing in Healthcare?

- June 23, 2023
- Posted by Kristen Edwards

23 Jun

In the complex landscape of healthcare, the credentials of medical professionals play a crucial role in ensuring safe and effective patient care. Credentialing in healthcare is one of the important aspects of validating the practitioners’ credentials. The right credentialing type smooths the workflow and reduces revenue delays. However, the right type of credentialing can be done through the correct software, which simplifies the day-to-day process and increases efficiency.

Delegated credentialing is a process that allows healthcare organizations to rely on external entities, such as health plans or managed care organizations, to verify and approve the qualifications of healthcare providers. Delegated credentialing is getting increasingly popular due to the expediting turnaround process of the providers, which reduces the time consumption for practitioners and the paperwork required. Hover over the following information to learn about delegated credentialing in healthcare and understand healthcare credentialing.

## Understanding Medical Credentialing

Understanding the fundamentals of credentialing is important before diving into delegated credentialing. The process of evaluating and confirming a healthcare provider’s credentials, experience, and competence is known as credentialing. Making sure that practitioners satisfy the necessary criteria, it entails assessing elements like educational background, training, licensure, certificates, and professional references.

## What is Delegated Credentialing?

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A cooperative strategy called “delegated credentialing” enables healthcare organizations to assign the duty of accrediting healthcare providers to outside organizations. These organizations, frequently health plans or managed care organizations, have systems and procedures in place to examine and approve credentials, ensuring that medical practitioners meet the appropriate requirements.

Healthcare organizations can streamline operations and lessen administrative burdens by outsourcing credentialing. With this method, healthcare practitioners can be a part of numerous health plans or networks without needing to go through separate credentialing procedures for each.

## The process of Delegated Credentialing

Delegated credentialing includes several steps. Healthcare providers initially submit their applications for credentialing to the outside organization in charge of credentialing. The organization then assesses the application, reviewing records, including educational credentials, licenses, certificates, criminal records, and professional references.

When the review is over, the outside organization decides if the healthcare provider satisfies the requirements. The provider is given access to the health plan or network if they are given the go-ahead and are given credentialing status. It is important to remember that delegated credentialing calls for continual review and monitoring to ensure that providers maintain their credentials and abide by requirements.

## Benefits of Delegated Credentialing

Both healthcare practitioners and organizations can profit from delegated credentialing in a number of ways. Removing the need for separate credentialing processes, it makes it easier for healthcare practitioners to join different health plans or networks. Providers can concentrate on providing patient care because of the time and money saved.

Healthcare organizations also benefit from delegated credentialing. By relying on external entities with expertise in credentialing, organizations can expedite the process while maintaining high standards of quality and compliance. This approach reduces administrative burdens and enables organizations to efficiently expand their network of healthcare providers.

Here are some notable benefits of delegated credentialing;

### Improved efficiency while streamlined processing

With delegating credentialing, healthcare organizations streamline their efficiency significantly for processing. However, while outsourcing credentialing, healthcare organizations can release pressure, utilize resources, and save time effectively. This way, providers can focus on providing efficient healthcare to patients without worrying about the time spent on credentialing.

### Provider network expansion

When credentialing is delegated, it helps in expanding the provider network. Hiring new providers and performing credentialing for them becomes flawless as it improves the ability to retain and recruit. The process becomes quick, and accessing healthcare organizations associated with credentialing becomes efficient.

### Improved revenue cycle management

With delegated credentialing, healthcare organizations can save a lot in terms of administrative and labor expenses. Hence, the saved cost can be reinvested in the cost required in research and development and in patient care.

In addition, the revenue cycle management can also be improved by ensuring that the credentialing is done accurately and efficiently, which expedites the process. With this, the organization’s overall financial health can also be improved.

## Challenges in Delegated Credentialing

While delegated credentialing has many benefits, there are some drawbacks as well. Ensuring uniform credentialing requirements among different outside entities is one of the key challenges. Carefully assessing and choosing credible organizations that maintain high standards and accurate and current information is essential for healthcare organizations.

Collaboration and effective communication between the healthcare organization and a third party are also essential to a smooth and efficient credentialing process. A successful delegated credentialing program requires open lines of communication, clearly stated expectations and a dependable feedback mechanism to overcome and maintain potential obstacles.

## The impact of Delegated Credentialing on Healthcare providers

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The impact of delegated credentialing on healthcare practitioners is significant. By affiliating with multiple health plans or networks, it becomes simpler for providers to expand their patient bases and gain access to a wider range of services. Healthcare professionals may thus experience more rapid career progress and stable financial situations. In the healthcare industry, delegated credentialing also promotes industry-wide cooperation and standardization. By adhering to universal credentialing requirements set by organizations, healthcare professionals raise the general standards and safety of patient care.

## The impact of Delegated Credentialing on Patients

Patients are affected by delegated credentialing as well. The credentialing procedure provides patients confidence and a sense of security while knowing that the healthcare professionals treating them are skilled and knowledgeable. Verifying the providers’ qualifications and certifying compliance with industry norms helps to ensure patient safety.

Delegated credentialing additionally offers patients broader access to a larger selection of healthcare professionals, extending their chances for alternative options. They have a choice to seek care from experts or providers affiliated with other health plans, offering them choices that meet their preferences and healthcare requirements.

## Best practices for effectively Delegated Credentialing in Healthcare

To ensure the effectiveness of delegated credentialing, healthcare organizations should follow best practices. These include:

- Choosing external organizations for certification after performing careful due diligence.
- Setting up clear lines of communication and expectations with the selected external entity.
- Implementing strong data management systems to ensure correct and current provider information.
- Regularly monitoring and reviewing the performance of external organizations to maintain quality assurance.
- Ensuring ongoing education and training for staff involved in the delegated credentialing process.

## Future trends in Delegated Credentialing

Delegated credentialing is expected to adapt to new trends and developments as the healthcare environment changes. The use of technology to automate the credentialing process, increased cooperation between healthcare organizations and third parties, and the incorporation of artificial intelligence for more effective and precise credentialing assessments are a few potential future trends in delegated credentialing. Credentialing in healthcare is anticipated to improve and explore new potential with these efficiencies and accuracy.

## Conclusion

By expediting the verification and licensing of healthcare professionals, delegated credentialing plays a critical role in the healthcare sector. Participating in numerous health plans or systems is made easier for providers while also assuring patient security and easy access to high-quality healthcare. Healthcare organizations can benefit from delegated credentialing and support an effective, patient-focused healthcare system by adhering to best practices and embracing emerging trends.

### Frequently Asked Questions (FAQs)

1. What is the difference between delegated credentialing and traditional credentialing?

Traditional credentialing is performed in-house by the healthcare organization, whereas delegated credentialing entails outsourcing the credentialing process to external companies.

2. How does delegated credentialing ensure patient safety?

By confirming the credentials and proficiency of healthcare practitioners, delegated credentialing enhances patient safety by lowering the possibility of inadequate care and medical errors.

3. Can healthcare organizations delegate the credentialing process to external entities?

Healthcare organizations can assign the credentialing process to third-party organizations with the knowledge and resources for in-depth credentialing evaluations, such as managed care organizations or health plans.

4. Is delegated credentialing applicable to all healthcare professions?

Physicians, nurses, dentists, and other allied health professionals are among the healthcare professions that may use delegated credentialing. Depending on the occupation and governing rules, the precise criteria could change.

5. What are the key elements of a successful delegated credentialing program?

A successful delegated credentialing program consists of a considerate choice among organizations, efficient communication and teamwork, regular monitoring and assessment, accurate data storage, and ongoing education and training for the staff involved in the procedure.

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