Guides

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.

What Is Roster Management?

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.

Provider credentialing is a multistep process healthcare systems and plans use to verify healthcare providers' qualifications and competency before granting network inclusion or clinical privileges. This process ensures that clinicians are vetted and compliant with state and federal regulations. It applies to providers intending to get in-network with health plans or employed and affiliated practitioners of health systems.