Credentialing has always been one of the biggest roadblocks for healthcare organizations. Whether you run a growing mental health group, a primary care clinic, a specialty practice, or an MSO, you already know the problem — every new provider means more paperwork, more follow-ups with payers, and long waiting periods before they can start seeing insured patients.
This is where delegated credentialing comes in. Instead of waiting 60–120 days for insurance companies to complete the credentialing process, some provider organizations are allowed to credential their own providers in-house.
After that, the payer only reviews the files and audits the organization, not every individual credentialing application.
For larger or fast-growing practices, this approach can significantly speed up onboarding, reduce administrative stress, and help providers get reimbursed sooner.
If you’ve ever felt stuck waiting on payer timelines, delegated credentialing may be the system that finally gives you more control.
Key Takeaways
- What It Is: Delegated credentialing is when an insurance company (payer) gives a healthcare organization (like a hospital or large group practice) the authority to credential its own providers in-house.
- The Goal: To significantly speed up the onboarding process for new providers, allowing them to see insured patients and generate revenue much faster than the standard 60–120 day payer timeline.
- The Workload Shift: The provider organization takes over the detailed work, including verifying licenses, education, and running background checks, ensuring everything meets NCQA standards.
- Payer’s Role: The payer still maintains oversight. They review the organization’s policies and conduct periodic audits of the provider files to ensure compliance.
- Who Qualifies: Only organizations with strong, structured, and compliant credentialing processes typically qualify. This includes large medical groups, hospitals, MSOs, and FQHCs.
What Is Delegated Credentialing?
Delegated credentialing is when an insurance company gives a provider organization — such as a clinic, hospital, group practice, or MSO — the authority to credential its own providers instead of sending every application to the payer.
In simple terms:
You take over the credentialing work that the insurance company normally does.
This means your organization handles tasks like:
- Verifying licenses, education, and board certifications
- Running background checks
- Keeping provider files updated
- Making sure everything meets payer and NCQA standards
Once your internal credentialing team completes these steps, you send the information to the payer, and they approve the provider based on your verification — not their own lengthy process.
The payer still audits your credentialing work regularly, but the day-to-day credentialing happens within your organization. This is why delegated credentialing can dramatically reduce wait times and give you more control over provider onboarding.
How Delegated Credentialing Works
Delegated credentialing may sound complicated, but the process is actually straightforward once a group is approved by the payer.
Here’s how it typically works:
The Provider Group Applies for Delegation
Your organization must show the payer that you already have a strong credentialing process in place. This includes policies, trained staff, and a reliable way to keep provider files updated.
The Payer Reviews Your Credentialing Policies
Insurance companies want to confirm that your workflow meets industry standards — especially NCQA requirements. They check how you verify licenses, education, background checks, malpractice history, and more.
Both Parties Sign a Delegation Agreement
Once approved, the payer signs an agreement that officially allows your group to handle credentialing for your own providers. This document outlines what you’re responsible for and how often the payer will audit your work.
Your Internal Team Performs Credentialing
Your credentialing staff takes over the full process:
- Primary source verification
- File maintenance
- Monitoring expirables
- Following internal credentialing policies
You now control the timeline instead of waiting on the payer.
You Submit Regular Rosters to the Payer
Your organization sends updated provider lists and credentialing files to the payer on a schedule — usually monthly or quarterly.
Payer Conducts Periodic Audits
To maintain delegated status, payers audit your credentialing process once or twice a year. As long as your files are clean and compliant, the delegated relationship continues.
This system speeds up onboarding and reduces back-and-forth with insurance companies, making it ideal for organizations that frequently add new providers.
Who Qualifies for Delegated Credentialing?
Not every healthcare organization can receive delegated credentialing. Payers only approve groups that already have a strong, well-structured credentialing system.
Here are the types of organizations that typically qualify:
1. Large Medical Groups & Physician Organizations
Groups with dozens or hundreds of providers are the most common candidates.
Why? Because they already manage credentialing internally and handle high volumes of provider onboarding.
Examples:
- Multi-specialty physician groups
- Independent practice associations (IPAs)
- Large primary care networks
2. Hospitals & Health Systems
Hospitals already have advanced credentialing departments and committees, making them ideal for delegation. Their internal processes often meet NCQA-level standards.
3. FQHCs & Community Health Centers
Federally Qualified Health Centers and community clinics can qualify if they maintain strong documentation and credentialing policies.
4. MSOs (Management Services Organizations)
MSOs that manage credentialing for multiple practices may qualify if they:
- Follow NCQA standards
- Have a dedicated credentialing team
- Maintain clear policies & file audits
5. Behavioral Health Organizations
Large behavioral health networks with multiple licensed professionals (LCSWs, LMFTs, Psychiatrists, Counselors) may qualify if the organization maintains strong credentialing oversight.
Benefits of Delegated Credentialing
Delegated credentialing offers major advantages for healthcare organizations. The biggest benefit is speed—providers get credentialed and enrolled much faster because the organization controls the process instead of waiting on payers. This means quicker approval, quicker onboarding, and quicker revenue.
It also reduces repetitive paperwork. Instead of sending documents to multiple insurance companies, the organization verifies everything once and shares the results with all delegated payers.
Finally, it gives organizations more control and consistency. They can manage their own timelines, maintain better provider records, and avoid long delays that slow down patient care and billing.
Challenges of Delegated Credentialing
While delegated credentialing has clear benefits, it also comes with responsibilities. The biggest challenge is that the organization must meet strict payer standards.
This includes maintaining a compliant credentialing process, following NCQA guidelines, and keeping accurate, up-to-date provider files at all times.
There’s also more administrative work. Organizations need a trained credentialing team, strong documentation practices, and regular audits to stay compliant.
If anything is missed—expired licenses, outdated documents, or incomplete files—the payer can revoke the delegation agreement.
In short, delegated credentialing gives more control, but it also requires consistent oversight and strong internal processes.
How Delegated Credentialing Impacts Your Practice
Delegated credentialing can significantly speed up how quickly your providers get enrolled and start seeing insured patients.
Since your organization handles the entire verification process, you’re not waiting on the payer’s long review timelines. This means faster approvals, quicker revenue flow, and fewer delays in onboarding new providers.
It also improves the overall provider experience. New clinicians can start working sooner, and your team has more control over timelines instead of relying on payer bottlenecks.
For larger groups, this can reduce administrative costs and create smoother operations. Instead of tracking multiple payer processes, everything happens in one internal system—making credentialing more predictable and efficient.
How Get Credentialing Done Helps with Delegation
Getting delegated credentialing approval from payers isn’t easy — you need clean processes, organized documentation, and a proven track record. Get Credentialing Done helps provider groups build all the systems payers look for.
We help you:
- Set up strong internal credentialing workflows that match payer standards.
- Organize provider files (licenses, NPIs, CAQH, board certifications, background checks) so they’re always audit-ready.
- Review your current credentialing performance and fix gaps that could prevent delegation.
- Prepare all the documentation needed for payer delegation evaluations.
- Communicate with insurance companies during the assessment process.
By making your credentialing process structured, consistent, and compliant, GCD helps your group become a strong candidate for delegated status — so you can credential faster, onboard providers sooner, and reduce payer delays.
FAQ
Delegated credentialing means a large medical group or hospital is given permission by an insurance company to credential and approve its own providers, instead of waiting for the insurer to do it.
The biggest benefit is speed. It significantly reduces the time it takes for new providers to get approved, allowing them to start seeing patients and billing much sooner.
Delegated credentialing is typically granted to large organizations such as hospital systems, Management Services Organizations (MSOs), and medical groups that already have strong internal credentialing processes in place.
In regular credentialing, the insurance company performs all the primary verification checks. With delegated credentialing, your organization handles the credentialing work, and the insurer only reviews and audits your files to ensure compliance.
No. The insurance company continues to oversee the process by requiring routine provider rosters and conducting periodic audits, usually once or twice a year, to make sure your credentialing files meet their standards.
If your organization misses important items—such as expired licenses or incomplete documentation—and fails a payer audit, the insurance company can revoke the delegation agreement. If that happens, you return to the standard, slower credentialing process managed by the payer.