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What is delegated credentialing and how to use it to get more control over revenue cycles

Understanding 'what is delegated credentialing' is crucial in today's healthcare landscape. Instead of navigating the intricate maze of traditional enrollment, delegated credentialing offers a streamlined approach, allowing healthcare providers to expedite the process and focus more on patient care.

What is delegated credentialing and why it is a paradigm shift

What is delegated credentialing? In healthcare, credentialing is essential for providers to accept insurance. Traditionally, each provider undergoes a lengthy enrollment process. Delegated credentialing simplifies this. Here, payers entrust the credentialing task to the provider groups they partner with, streamlining the process.

Imagine a city where every resident verifies each visitor's identity — that's traditional credentialing. Delegated credentialing is like having a trusted agency do this — it's efficient and logical.

Credentialing involves collecting and reviewing applications, verifying data, and getting approvals. It's detailed and crucial. Delegated credentialing offers a faster route, letting healthcare professionals focus more on patient care.

The revenue implications of delegated credentialing

Every day a provider waits to be credentialed is a day of lost revenue. These delays aren't just frustrating; they have a real financial impact. For organizations, this can amount to significant losses, with a one-day delay in provider onboarding costing a medical group $10,122.

The intersection of credentialing and revenue cycle management

Credentialing and revenue cycle management often operate in silos within a healthcare organization. But they're closely linked. Accurate credentialing data ensures that billing is accurate, and providers get paid correctly. According to MGMA, a poorly organized credentialing process can significantly impact a practice's revenue cycle. In fact, more than half of medical practices reported an increase in denials related to provider credentialing in 2021. Such denials can affect key performance indicators like days in A/R, aging claims, and the clean claim rate. It's a domino effect: get credentialing right, and the revenue cycle runs smoother.

The power of delegated credentialing (why you shouldn’t overlook its value)

Understanding what is delegated credentialing and implementing it reveals its immense value for healthcare organizations:

  • It quickens provider onboarding: It's a race against time for healthcare facilities enrolling and onboarding providers. Delegated credentialing slashes time, propelling providers to start their practice sooner. When performing credentialing themselves, provider groups do not have to wait for payers to get to their providers when they may be handling thousands of others. The time to complete primary source verifications will take days instead of weeks or months.
  • It speeds up efficient reimbursements: Faster credentialing leads to quicker reimbursement — It's a direct line to improved cash flow.
  • It leads to operational control and cost savings: When going through the enrollment process, provider groups have to send a ton of information to payers in order to have them go through the credentialing process. Once they have sent the information, there is often no way to know what its status is. Delegated credentialing cuts down on administrative overhead. Less paperwork, fewer delays and more transparency
  • It offers more control over revenue cycles: A predictable, streamlined credentialing process makes forecasting and managing revenue cycles a smoother sail towards financial stability, not a stormy voyage. This is a subsection of speed, but the faster your providers can be credentialed, the faster they can begin accepting payments and charging for the work that they do, and the faster the provider group can start making money from their work.

Gaining value with delegated credentialing

Medallion's approach to delegated credentialing is straightforward. Here's how we help:

  • Your needs are our priority: Start by understanding your current landscape. How many providers are you onboarding? What's the average time for credentialing? Medallion was built for scale, helping you to expand your operations without increasing headcount. With an efficient workflow, you can simplify the process of submitting multiple online - or paper - applications to save as much as 78% time on your administrative task time.
  • You’re working with a qualified team: If you're thinking of outsourcing, it’s key to pick a CVO that knows its stuff. Experience matters. With Medallion, you’re backed by a team deeply versed in credentialing, executing on tasks to drive results, generating 99.5% accurate verifications with a state-of-the-art API, and you can do it all from an intuitive and modern platform. 
  • You’ll always stay on top of evolving regulations: The rules around credentialing can be complex. Whether it's NCQA guidelines or CMS regulations, staying informed is crucial. And if you have a certification like NCQA, like Medallion does, it can speed up the process.
  • You’ll have everything in the process centralized and where you can see it: Whether you're managing credentialing in-house or outsourcing, keep the process centralized. It's the best way to avoid duplication and errors. Medallion offers you full visibility of your provider data so you can maintain access to the right information when you need it - at any step of the credentialing verification process.
  • Your account will be always up to date: Healthcare is always evolving. We regularly review your processes to ensure they're current. With a centralized operation, any of the usual problems caused by separate workflows are a thing of the past. 

The bottom line? The less time providers spend on administrative tasks like credentialing, the more time they can spend with patients. And faster credentialing means fewer claim denials. It's a win-win.

Prioritize change, or lose the long game

The healthcare sector is evolving rapidly. Clinging to outdated methods might leave you behind, but understanding what is delegated credentialing and how your organization can leverage it and its benefits, can be your ticket to adapt and excel. This approach isn't just about speed — it's about enhancing quality and efficiency. In a domain where precision is critical, making informed changes can set you apart. Ready to make a change? Learn more about Medallion’s delegated credentialing consulting solutions and how we can help.