Delegated Credentialing

Delegated credentialing is a process where healthcare organizations, like hospitals or physician groups, take over the responsibility of credentialing their providers from insurance companies.

This involves verifying qualifications, such as education, training, and licenses, and ensuring compliance with payer and regulatory standards. Instead of each physician undergoing credentialing directly with payers, delegated entities handle the entire process and submit rosters for approval.

Why Does It Matter?

Credentialing is a major bottleneck in healthcare.

Onboarding new physicians can take 90–180 days or more, delaying their ability to see patients and generate revenue. Delegated credentialing aims to streamline this process, enabling faster onboarding and improving operational efficiency for healthcare entities. By taking control, hospitals and other delegated entities can better manage large clinician networks, avoid payer delays, and ensure compliance.

Challenges of Delegated Credentialing

While it offers efficiency, delegated credentialing isn’t simple. Organizations must meet strict standards from groups like NCQA, undergo regular audits, and maintain accurate, up-to-date records for all providers. Failure to comply can lead to payer penalties or loss of delegated authority.

Who’s Simplifying the Process?

Startups like Assured use automation, AI, and credentialing experts to handle everything from provider verification to roster creation and ongoing monitoring. This saves delegated entities time, reduces administrative burden, and ensures compliance—turning credentialing from a headache into a streamlined asset.

For healthcare entities, delegated credentialing is both a responsibility and an opportunity to improve onboarding, revenue cycles, and provider satisfaction.

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