Delegated credentialing is more than an operational efficiency—it’s a strategic approach that benefits healthcare organizations, providers, and payers alike. By shifting responsibility for the credentialing process to trusted organizations, payers streamline workflows while maintaining oversight through rigorous standards. For Provider Lifecycle Professionals (PLPs), delegated credentialing represents an opportunity to demonstrate their expertise while enhancing the value they bring to their organizations.
Here are the top reasons delegated credentialing has become a cornerstone of modern healthcare operations.
1. Accelerated Provider Onboarding
One of the most significant benefits of delegated credentialing is speed. Traditional credentialing processes often involve multiple steps between payers and healthcare organizations, creating delays that can hinder a provider’s ability to deliver care. Delegated credentialing eliminates this back-and-forth by granting organizations the authority to credential providers directly.
With this streamlined process, providers can begin practicing and billing for their services sooner, reducing revenue disruptions and improving patient access to care.
2. Enhanced Provider and Payer Relationships
Delegated credentialing fosters a collaborative relationship between healthcare organizations and payers. By entrusting credentialing responsibilities to the organization, payers demonstrate confidence in the PLP team’s capabilities. This trust strengthens partnerships and creates opportunities for ongoing collaboration in other areas, such as quality improvement initiatives and compliance strategies.
3. Cost Savings for Both Parties
Credentialing is a labor-intensive process that requires significant administrative resources. When healthcare organizations take on this responsibility through delegation, payers reduce their operational burden and associated costs. At the same time, organizations can leverage existing workflows and technology to manage credentialing more efficiently, resulting in cost savings on both sides.
These efficiencies are particularly valuable for large health systems or organizations with a high volume of providers, where credentialing economies of scale can significantly impact the bottom line.
4. Improved Compliance and Accountability
Delegated credentialing doesn’t mean sacrificing oversight. Payers require organizations to meet strict accreditation standards—such as those set by the National Committee for Quality Assurance (NCQA)—before granting delegated authority. Regular audits and compliance reviews ensure that credentialing processes align with industry standards and payer expectations.
For PLPs, these standards provide an opportunity to showcase their expertise and maintain the organization’s credibility. Successfully managing delegated credentialing demonstrates the team’s ability to handle complex processes with precision and reliability.
5. Customization and Control
Delegated credentialing empowers organizations to tailor credentialing processes to their unique needs. Instead of adhering to a payer’s predetermined workflow, PLPs can develop systems that align with their organization’s structure, resources, and goals.
This control extends to technology choices, data management practices, and workflow integration, enabling greater efficiency and consistency across credentialing efforts. When organizations have the flexibility to manage their processes, they can adapt more effectively to changes in payer requirements or regulatory updates.
6. Scalability for Growing Organizations
As healthcare organizations grow—whether through mergers, acquisitions, or the addition of new providers—credentialing demands often increase exponentially. Delegated credentialing offers a scalable solution, allowing organizations to manage a higher volume of credentialing tasks without overwhelming payer systems.
This scalability is particularly valuable in competitive markets, where rapid growth and provider expansion are essential to staying ahead.
7. Elevating the Role of PLPs
Delegated credentialing highlights the critical role PLPs play in healthcare organizations. By managing complex credentialing processes and maintaining compliance with rigorous standards, PLPs demonstrate their strategic value. Their expertise ensures that delegated credentialing is not only effective but also a key contributor to organizational success.
Delegated credentialing is more than a process—it’s a strategy that drives efficiency, strengthens partnerships, and elevates the profession of PLPs. By embracing delegation, organizations position themselves to adapt to the demands of modern healthcare while maintaining the highest standards of quality and compliance.