Delegated Provider Credentialing
Entering into and successfully maintaining a delegated credentialing contract program is a significant undertaking.
TractManager’s cloud-based credentialing and enrollment platform, CARE, makes managing data and delegated contracts significantly easier.
Establish Delegated Credentialing Agreements
Take control of the credentialing process by establishing delegation agreements with payers.
TractManager’s credentialing service professionals implement workflows grounded in best practices and informed by powerful analytics to streamline operations and accelerate the entire credentialing lifecycle.
What is Delegated Credentialing?
Delegated credentialing occurs when a healthcare entity gives another healthcare entity the authority to credential its practitioners.
Insurance payers delegate the primary source verification process to a provider/hospital group in exchange for expediting the credentialing and enrollment timeframes.
Large groups, those exceeding 100 providers, often set up delegated contracts with health plans to ease the burden of submitting hundreds of provider applications. To do so, they need a fully compliant credentialing program that ensures the proper infrastructure, resources, and personnel to support the credentialing function. In most cases, such arrangements require partnering with a knowledgeable third-party vendor that can offer guidance throughout the delegation process in addition to full credentialing and enrollment services.
Delegation Expedites the Credentialing Process
Delegated credentialing significantly improves an organization’s efficiency, provider experience, and revenue cycle management. With automated workflows and business intelligence tools, TractManager’s software solution was designed to allow users to easily create and populate payer-specific delegated credentialing rosters.
Our credentialing program provides a comprehensive suite of services, and our technology is backed by a team of credentialing experts. From PSV to Peer Review Support, our experts ensure the timely and compliant processing of participating providers. Our team will populate and submit delegated credentialing rosters, follow up with payers, and regularly reconcile provider profiles to ensure timely and accurate enrollment.
Delegated Credentialing services include:
Consulting to assist in credentialing program development
and payer delegation
NCQA Accredited in Credentialing
- Primary Source Verifications
- Peer Review Support and Decisions
- Ongoing Provider Data Management
Delegated Payer Enrollment
- Generates payer-specific delegated rosters
- Reviews payer-specific rosters for accuracy
- Submits payer-specific rosters to the payers
- Conducts regular and rigorous follow-up on all payer-specific rosters
Credentialing delays mean dollars lost.
Every day a provider doesn’t see patients equals lost revenue for your health system.
On average, it could take up to 6 months to manually credential a new provider, and that can lead to revenue loss and unhappy providers. If your current credentialing process is manual, error-prone, and vulnerable to risks, you need a solution that can speed up the process without compromising accuracy or compliance. We’re one of two CVOs to receive NCQA Accreditation in Credentialing. Our comprehensive Provider Management solution serves over 48,000 providers across the country.
To Delegate or Not to Delegate – That is the Credentialing Question
Realize improvements in the processes that govern the growth and representation of your network, shorten turnaround times for network participation, enhance provider experience and brand integrity, and expedite access to revenue.