If you’ve spent any time getting providers credentialed and enrolled with payors, you’ve probably heard both “provider enrollment” and “delegated” thrown around. They’re related but not the same, and confusing the two costs time and money.
Standard Provider Enrollment (Non-Delegated)
This is the traditional route. Providers are onboarded onto H3’s Elevate platform and all documents are reviewed so we can begin to submit credentialing and enrollment applications. We include supporting documents directly to each insurance payor. The payor then does the full credentialing: primary source verification, malpractice history, sanctions check, and decides whether to enroll the provider in their network.
- Downside is that you’re at the mercy of the payor’s review timeline (commonly 60-120 plus days, sometimes longer) resulting in slower onboarding and thus delayed billing and revenue.
- Requires less internal practice infrastructure on your end.
Delegated Credentialing/Enrollment
With delegated credentialing, the payor enters into a written agreement that delegates credentialing authority to a healthcare organization like a hospital, large medical group, IPA (Independent Practice Association or Independent Physician Association), or MSO (Management Services Organization).
The delegated organization handles all verification and decision-making according to their documented bylaws and procedures, often aligned to the payor’s standards and or NCQA (National Committee for Quality Assurance). Once approved internally by the group’s delegated process, providers are typically added then via a roster or bulk submission to the payor rather than via individual applications.
- The result is much faster credentialing (often 30-60 days once the process is running smoothly) with greater control and efficiency when you have high provider volume.
- Solid internal processes, policies, reporting and auditing as Committee review is performed by the organization’s credentialing committee to evaluate and approve or deny provider files.
- Ideal for larger organizations.
Credentialing confirms qualification, but payor enrollment authorizes billing and you need both to get reimbursed. At H3 Healthcare, we take standard provider enrollment completely off your hands by managing application submission and CAQH upkeep. We handle the process from start to finish so providers can focus on patient care, and your billing starts as soon as possible. We also help teams evaluate, establish, and execute delegated credentialing programs with payors and hospitals on behalf of clients.
Reach out to learn more!
