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Have you ever tried to hand off credentialing tasks only to end up double-checking everything? One missing document, one unclear responsibility, or one undocumented step can slow approvals, trigger compliance issues, or create rework you did not plan for.
The truth is that delegation only works when your credentialing program is built for it. That means clear workflows, documented requirements, defined ownership, and systems that do not rely on tribal knowledge to function.
In this guide, we walk through how to build a credentialing program your team can run without micromanagement. You will learn how to structure your processes, set expectations, and create repeatable systems that scale.
What is delegated credentialing?
Delegated credentialing is when a healthcare organization is authorized to credential its own providers instead of submitting individual applications to each payor. Rather than repeating the same paperwork across payors, the organization follows an approved process that payors trust and accept. Once delegation is granted, the organization credentials providers internally and submits them as complete, verified files.
Delegated credentialing reduces provider activation timelines, cuts administrative costs, and simplifies roster submissions compared to one-off applications. Providers get credentialed faster, teams spend less time chasing documents, and payors receive more consistent submissions.
When does delegated credentialing make sense?
Delegated credentialing is not something organizations pursue overnight. It is a capability built as scale and complexity increase. There are three common indicators that signal readiness.
You should consider delegated credentialing if you have:
- 100 or more practitioners (some payors require minimums)
- Providers licensed in multiple states
- Contracts with five or more payors, or a near-term plan to reach that level
Scale matters. If you manage 100 or more practitioners, many payors begin to see you as a credible delegation candidate. At that size, handling individual credentialing files, verifications, and submissions becomes time-consuming and expensive. Delegation centralizes that work and reduces repetition.
Operational complexity matters. When providers are licensed in multiple states, credentialing volume multiplies quickly. Each state introduces its own timelines, renewal cycles, and verification requirements. Without standardized processes, teams end up reacting instead of planning. Delegated credentialing introduces consistency and control.
Payor mix matters. Organizations contracted with five or more payors benefit most from delegation. Instead of tailoring submissions to each payor, the organization uses a single, approved credentialing system.
Starting early is critical. Delegation contracts typically take six to twelve months to complete, including audits, policy reviews, and operational assessments. Building readiness before credentialing becomes a bottleneck puts organizations in a stronger position to scale without delays.
The 5 components payors require for delegation
If payors are going to trust your organization with delegated credentialing, your program must look and operate like theirs. That means having the right structure, documentation, and controls in place before applying.
There are five core components payors expect to see.
1. Written policies and procedures
A delegation-ready program starts with clear, written policies and procedures. Payors expect documented standards aligned with NCQA, CMS, and applicable state regulations. These policies must clearly define how credentialing works inside your organization, including application processing, verification standards, approval criteria, provider appeals, timelines, roles, and escalation paths.
The goal is consistency. If two credentialing specialists handle the same provider file, they should reach the same outcome using the same rules. Payors review these documents closely during delegation audits to ensure proof that your process is structured, repeatable, and compliant.
2. Credentialing committee and governance
Payors require a formal credentialing committee with documented authority and oversight.
The committee is responsible for reviewing completed files and making final credentialing decisions. It typically includes a licensed physician (MD or DO) and, at a minimum, a compliance or quality leader. Some organizations also include legal or operations leadership, depending on size and risk profile.
The committee must meet at least monthly, and those meetings must be documented. Agendas, attendance, voting outcomes, and rationale for approvals or denials all matter. From a payor’s perspective, this committee is the safeguard that ensures credentialing decisions are not rushed, biased, or inconsistent.
3. Primary Source Verification (PSV)
Primary Source Verification is one of the most important and heavily audited parts of delegated credentialing. Payors are explicit on this point: self-reported information is not sufficient.
Organizations must verify credentials directly from the original source. This includes:
- State licenses
- DEA registrations
- Education and training
- Board certification
- Malpractice history
- Work history
- Sanctions across federal and state databases, including OIG, SAM, NPDB, and state exclusion lists
Every verification must be dated, sourced, and retained in accordance with the documentation requirements. Missing or expired PSV evidence is one of the most common reasons delegation applications fail.
This is also where scale becomes challenging. Managing PSV across dozens or hundreds of providers quickly turns into a data problem. Platforms like Assured, which handle PSV across 2,000+ primary sources, are designed to support this volume without sacrificing accuracy or audit readiness.
4. Ongoing monitoring and risk management
Delegated credentialing does not stop once a provider is approved. Payors expect continuous monitoring to identify issues in real time.
At a minimum, this includes ongoing sanctions monitoring across OIG, SAM, NPDB, and state exclusion lists, as well as active tracking of license and certification expirations. Most payors require monthly monitoring logs that document when checks were performed and what actions were taken if issues were identified.
This system protects both the payor and the organization. If a provider becomes excluded or a license lapses, delays in detection create immediate compliance exposure. Effective monitoring demonstrates that the organization is actively managing risk, not just credentialing providers.
5. Re-credentialing and ongoing compliance
Payors also require a formal re-credentialing process, typically every 36 months in line with NCQA standards. All primary sources must be re-verified, current performance and history reviewed, and the provider file presented back to the credentialing committee for approval. Documentation standards are just as strict as during initial credentialing.
Organizations that underestimate re-credentialing often struggle after delegation is granted. Without a structured process, files pile up, and deadlines are missed. A delegation-ready program plans for re-credentialing with clear timelines, ownership, and tracking built into daily operations.
Together, these five components form the foundation that payors evaluate when determining delegation readiness. If even one is weak or informal, securing approval becomes significantly harder.
Credentialing program requirements at a glance
A delegation-ready credentialing program must include:
1. Policies and procedures
- Written and formal
- Aligned with NCQA, CMS, and state regulations
- Clearly documented workflows, standards, roles, and escalation paths
2. Credentialing committee
- Formal governance authority
- MD or DO and compliance or quality representation
- Monthly meetings with documented agendas, votes, and rationale
3. Primary Source Verification
- Verification from original sources only
- Dated, sourced, and retained documentation
- Ability to handle scale across thousands of sources
4. Ongoing monitoring
- Continuous sanctions and exclusions checks
- License and certification expiration tracking
- Monthly monitoring logs and documented follow-up actions
5. Re-credentialing
- Occurs every 36 months
- Full PSV, committee review, and approval documentation
What payors review during a pre-delegation audit
Before granting delegated credentialing authority, payors conduct a pre-delegation audit to confirm your program operates consistently, complies with regulations, and maintains complete documentation. Passing this audit is essential.
How the pre-delegation audit works
Step 1: Submit a delegation request
Provide a program overview highlighting policies, committee structure, monitoring systems, and oversight of any sub-delegated entities.
Step 2: Policies and procedures review
Payors evaluate written standards to confirm alignment with NCQA, CMS, and state requirements.
Step 3: Credentialing committee validation
Submit a committee roster and at least three months of meeting minutes showing attendance, voting outcomes, and decision rationale.
Step 4: Provider file audit
Payors review a sample of provider files to confirm that PSV documentation is complete and current.
Step 5: Monitoring and oversight review
Provide monthly monitoring logs and evidence of corrective actions. If a CVO is involved, payors verify that oversight procedures are in place.
Step 6: Audit outcome and agreement execution
Payors issue a pass/fail determination and execute a Delegated Credentialing Agreement if the requirements are met.
Documentation payors commonly request
- Written policies and procedures
- Credentialing committee member list
- Committee meeting minutes (three months or more)
- Complete provider roster
- Sample provider files with full PSV documentation
- Monthly monitoring logs
- Sub-delegation oversight documentation
How to build a delegation-ready program step by step
Payors do not delegate credentialing based on promises. They look for proof that a program already works.
Months 1 to 2: Foundation
Draft formal policies and procedures, establish the credentialing committee, and define authority and meeting cadence.
Months 2 to 3: Process setup
Implement PSV workflows, set up ongoing monitoring, and standardize provider file templates.
Months 3 to 4: Operationalize
Begin credentialing providers under the new program and hold documented committee meetings.
Months 4 to 6: Audit preparation
Accumulate at least three months of committee history, assemble provider file samples, and conduct internal audits.
Months 6 to 12: Payor engagement
Submit delegation requests, complete pre-delegation audits, remediate findings, and negotiate delegation agreements.
Partnering with a Credentialing Verification Organization can shorten this timeline. In many cases, what takes six to twelve months internally can be compressed into weeks because the infrastructure and audit discipline are already in place.
What changes after delegation is granted
Delegation is an ongoing operational commitment.
Monthly
- Submit updated provider rosters
- Run sanctions and exclusions monitoring
- Track license and certification expirations
- Maintain monitoring logs
Quarterly
- Submit reports if required by the Delegation Agreement
- Hold credentialing or peer review committee meetings
- Document decisions and corrective actions
Annually
- Complete payor audits
- Review and update policies and procedures
- Perform internal credentialing audits
- Conduct sub-delegation oversight reviews if applicable
Every 36 months
- Re-credential all providers with full verification and committee approval
Common reasons delegation programs fail
Delegation failures most often stem from documentation gaps or process drift, including:
- Incomplete or expired Primary Source Verification
- Missed committee meetings or undocumented decisions
- Lapsed sanctions or license monitoring
- Policies that do not match day-to-day practice
- Incomplete provider files
- Missed re-credentialing deadlines
Treating audit readiness as part of daily operations is the most reliable way to avoid these issues.
Should you build in-house or partner?
Once you decide to pursue delegation, the next decision is how to execute.
Build in-house if you have experienced credentialing staff, internal tools, and sufficient time to reach operational maturity.
Partner with a CVO if speed, efficiency, and reduced operational burden are priorities and internal expertise is limited.
Use a hybrid model if you want to retain credentialing committee authority while outsourcing PSV, monitoring, and documentation discipline to a partner like Assured.
The right choice depends on readiness, resources, and timelines.
Key metrics payors use to evaluate delegation
- Six to twelve months to secure a delegation agreement
- Three or more months of committee meeting history before audit
- Thirty-six-month re-credentialing cycle under NCQA standards
- Approximately thirty days for payors to roster providers post-delegation
- Sixty or more days for traditional credentialing without delegation
Need help becoming delegation-ready?
If you are preparing for delegated credentialing and want support with Primary Source Verification, monitoring, and audit-ready documentation, talk to our team.
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