TractManager helps a New York-based healthcare organization develop a fully compliant delegation program, reinstate its delegation agreement, and expand new delegation partnerships.This New York organization provides healthcare services including primary care, urgent care, specialty care, outpatient surgery, and imaging services.
300+ Facilities | 1,000 Providers | Based in New York
Client Case Study: Delegated Credentialing Services
A Delegated Credentialing agreement was revoked due to the failure of the organization’s previous CVO to follow the terms of their agreement.
After a healthcare organization establishes a delegated credentialing agreement with a health plan, that organization must follow the terms of that agreement and uphold credentialing standards established by the National Committee for Quality Assurance (NCQA) and the health plan. If the organization fails to meet those standards, the health plan can revoke the delegation agreement.
One health plan’s annual audit revealed that the healthcare organization’s credentialing files were missing significant information, including verifications, critical dates, and checklists. As a result of those credentialing omissions, that health plan pulled its delegation agreement. Consequently, all providers participating in that plan had to go through non-delegated credentialing (i.e., wait for the health plan to complete the credentialing process).
Non-delegated credentialing can take up to 180 days—significantly longer than the 30–45 days under a delegated agreement. Credentialing delays result in postponed reimbursements, reduced member access to providers, and frustrated providers.
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