Resources

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?

Credentialing is one of the most important—and resource-intensive—administrative functions for payers. Before a healthcare provider can join a network, insurers must verify their qualifications, licenses, training, work history, and other relevant credentials. Done manually, this process can be slow, costly, and prone to errors, adding to an already daunting and messy provider data maintenance process.

The volume of services delivered has long measured the value of healthcare: the number of tests ordered, procedures performed, or patients seen. This fee-for-service model has fueled rising costs without consistently improving patient outcomes. In response, payers, providers, and policymakers have been shifting toward a new framework: value-based care (VBC).