Provider Onboarding -

Establishing Delegation Agreements

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TRANSCRIPT:

“For provider networks that are frustrated with how long it’s taking them to become enrolled with health plans, what options do they have to address that? One of the ways that a network can quote unquote take control of the credentialing process, is by establishing delegation agreements with the payers. This means reaching pout to the payer, requesting a credentialing delegation agreement. The payers will then do an initial assessment of your operations. They will make sure that you have the infrastructure in place to support the credentialing process and then they will schedule what’s called a pre-delegation audit. They come on-site, or do this remotely, they review your policies and procedures, your QI program… the internal committees that are responsible for oversight, and the decision on credentialing files. They review files, they review minutes – so a lot goes into a pre-delegation assessment. Assuming that the organization preforms well and they pass the audit, then within about 30-60 days, depending on the payer, you have a fully executed delegation agreement. What this means, is that once you onboard a new provider, you put them through your own internal credentialing process. Your committee makes the decision and then you simply send a roster. Most health plans will have their own unique templates, an you get your provider loaded with the health plan. So instead of waiting for the health plan to do the credentialing, you do it internally. The biggest advantage of this is trimming down the entire process, which can take upwards of 120 days to 30 days.”

Anna Arutyunyan, VP of CVO Services

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