Delegated Credentialing:

Outsource for Greater Effectiveness


Delegated agreements with health care plans require significant oversight and verification. Consider the many services Managed Care Partners offers that can relieve some or all of your administrative burden:

Delegated initial and re-credentialing of practitioners:

  • Review of application and attestation to ensure it is complete and accurate
  • Primary source verification (customizable by state), including:
    -Board certification
    -DEA certification
    -Education and training
    -Hospital privileges
    -Professional liability insurance
    -Professional liability claims review
    -Federal and state sanctions and exclusions

    Delegated initial and re-credentialing of facilities:

    Primary source verification:

        • Facility licensure
        • DEA certification
        • CLIA/CLIA waiver
        • Pharmacy license
        • NPI
        • General liability insurance
        • General and professional liability claims review
        • Federal and state sanctions and exclusions

    Monthly preparation of information for your credentialing committee review:

    • Individual practitioner or facility checklists
    • Individual practitioner profile sheets
    • Committee minutes/review signature sheets

    Monthly practitioner and facility roster submission/payer enrollment to delegated payers:

    • Addition of new practitioner/facilities
    • Changes/updates of existing practitioner/facilities
    • Termination of practitioner/facilities
    • Submission of information customized to each health plan’s requirements

    Monthly continuous monitoring for practitioners including:

    • Federal and state sanctions/exclusions via:
      -Federal OIG
      -State OIG (if applicable)
      -System for Award Management
      -License to practice
    • Professional liability claims
      -Complaints reported to network and/or payers

      Maintenance of practitioner expirables including:

      -DEA certification
      -Board Certification


      • Quarterly delegated reporting to health plans as required
      • Annual payer policy audits as required by health plans
      • Annual and semi-annual credentialing audits by health plans
      • Maintaining and updating credentialing policies and procedures as required by health plans and accreditation oversight entities
      • Act as the liaison between the health plan and your network to resolve contracting questions or claims issues arising from credentialing/enrollment
      • Work directly with health plans to increase products (Medicaid, Medicare, PPO, HMO) included in delegated credentialing

      Managed Care Partners makes it easier for you to ensure your managed care services are in compliance and operating effectively.

      Managed Care Partners teams with critical access hospitals, small rural hospitals, and physician groups to create superior managed care financial performance.


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      Managed Care Partners, Inc.
      875 N. Addison Avenue
      Suite 200
      Elmhurst, IL 60126

      630.936.4211 - phone

      630.617.4222 - fax