Resources

In the evolving landscape of healthcare, modern technology holds incredible promise. Today, it’s driving advances in diagnostics, improving cost efficiency, and transforming administrative processes. The potential to enhance patient outcomes, reduce waste, and create a more connected, efficient healthcare system continues to grow, pointing to a future that’s smarter and more sustainable.

The healthcare industry simply cannot operate efficiently when provider information is fragmented, out-of-date, or siloed. Without appropriate Provider Data Management (PDM), health plans, systems, and patients face major failures:

Delegated credentialing is a formal process in which a health plan or payer gives a provider group, MSO, or delegated entity the authority to credential its own clinicians using NCQA-aligned standards. Instead of submitting every provider for manual review, organizations with mature credentialing operations can take on the responsibility themselves — reducing timelines, lowering administrative load, and improving network expansion. This guide breaks down what delegated credentialing is, how it works, the compliance requirements involved, and what it takes to qualify.

CVO credentialing is the practice of outsourcing the verification of a healthcare provider’s qualifications, such as education, training, licensure, work history, and board certifications, to a specialized organization. Accuracy and trust in credentialing begins with ensuring that providers are properly vetted so patients can be assured that their healthcare team is appropriately educated, credentialed, and trained to care for them.

Patient safety and regulatory compliance depend on maintaining accurate and up-to-date provider records. That’s why the credentialing process doesn’t end once a provider gets their original license, joins a network, and starts practicing. Instead, healthcare organizations must regularly reverify a provider’s qualifications, licensing, and certification to ensure that every provider in their network is qualified to practice.

In the healthcare ecosystem, a single resource sits at the intersection of multiple business-critical functions: provider data.

In healthcare, ensuring providers are qualified, licensed, and properly credentialed isn’t optional; it’s a regulatory requirement. Health plans and payers must confirm that every provider in their network is legitimate and meets the necessary professional standards. That’s where primary source verification (PSV) comes in.

What Is Roster Management?