Delegated Credentialing Services developed an NCQA-compliant credentialing program in 3 months.

Michigan’s largest health care system includes a network of eight hospitals, 145 outpatient locations, and nearly 5,000 physicians.

150+ Facilities  |  4,731 Physicians   |  Based in Michigan

Client Case Study: Delegated Credentialing Services

TractManager Case StudyThe Challenge

No credentialing program in place.

Credentialing is one of many quality management tools that healthcare organizations implement to monitor patient safety. While most will agree that it plays a valuable role in establishing and governing high-quality provider networks, very few appreciate its impact on strategic growth opportunities, revenue cycle management, and data integrity.

There is significant risk associated with provider credentialing — failures of credentialing have been linked to large malpractice suits, some of which set the legal precedents for the credentialing laws and regulations in place today. And while the fundamental structure of evaluating competency and qualifications remains unchanged across organization types, variations in regulations between state, federal, and accrediting bodies render already complex procedures nearly impossible to absorb.

Like many large healthcare organizations, this health system’s ACO and Physician Group quickly appreciated the value of an internal credentialing program and its impact on quality and strategic growth initiatives. Building a provider credentialing program is a time- and labor-intensive process that usually takes 8–12 months and requires considerable expertise and staff resources. This organization’s goal was to develop a quality-centric credentialing program that would allow it to establish delegation agreements with partner health plans.

The Solution?

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