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How to Use Delegated Credentialing to Gain Greater Control Over Revenue Cycles: An Overview

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Understanding and executing designated credentialing is becoming progressively pivotal in the healthcare business. This approach works on the traditionally complicated provider enrollment process, permitting healthcare providers to zero in on a more significant number of on-patient care instead of managerial weights. Designated credentialing addresses a significant change in how credentialing is dealt with, offering a more productive way to provide insurance acknowledgment for healthcare providers. It influences the credentialing process and significantly impacts a practice's revenue cycle. This article investigates the concept of designated credentialing, its effect on revenue cycles, and how healthcare organizations can use this methodology for more prominent operational proficiency and financial security.

Delegated Credentialing

It is imperative to comprehend the concept of "delegated credentialing" in the current healthcare environment. Delegated credentialing provides a simplified method that eliminates the need to navigate the complex labyrinth of traditional enrollment, enabling healthcare providers to expedite the process and concentrate more on patient care.

Why Is Delegated Credentialing A Paradigm Shift, And What Does It Entail?

Delegated credentialing: what is it? Credentialing is necessary for healthcare providers to accept insurance. Every provider has to go through a drawn-out enrollment procedure. Having delegated credentialing makes this easier. To streamline the process, payors assign the credentialing task to the provider groups they collaborate with. Imagine a city where everyone who lives there confirms the identity of every guest. That is traditional credentialing. Using a trusted agency for delegated credentialing makes sense and is more efficient. Obtaining approvals, collecting and evaluating applications, and validating data are all part of credentialing. It is essential and intricate. By providing a quicker path, delegated credentialing enables medical staff to concentrate more on patient care.

The Effects Of Delegated Credentialing On Revenue

A provider loses money every day and has to wait to get credentials. Not only are these delays annoying, but they also have a significant financial impact. This can result in considerable losses for the organization; for example, a medical group would lose $10,122 every day a provider onboarding delay occurred.

The Point Where Revenue Cycle Management And Credentialing Meet

Within a healthcare organization, credentialing and revenue cycle management frequently function independently. But they have a lot in common. Precise credentialing information guarantees correct invoicing and provider payment. A disorganized credentialing process can significantly affect a practice's revenue cycle, according to MGMA. Indeed, in 2021, over half of medical practices reported a rise in provider credentialing denials. These denials impact essential performance metrics, such as the clean claim rate, aging claims, and days in accounts receivable. Getting credentialing right has a cascading effect on how smoothly the revenue cycle operates.

The Importance Of Delegated Credentialing And Why You Should Not Undervalue It

Implementing delegated credentialing and comprehending what it entails shows how valuable it is for healthcare organizations:

  • It expedites onboarding of providers: Healthcare facilities that are enrolling and onboarding providers are in a race against time. Providers can launch their practices sooner, thanks to the time savings of delegated credentialing. Provider groups that handle thousands of credentialing requests do not have to wait for payors to reach their providers when they can handle credentialing themselves. Verifications of primary sources will take less than weeks or months; instead, they will take days.
  • It expedites prompt reimbursements: Quicker reimbursement results from faster credentialing - There is an obvious connection to better cash flow.
  • It results in cost savings and operational control: Provider groups must transmit copious amounts of data to payors during enrollment to initiate credentialing. It is frequently impossible to find out the status of the information once it has been sent. Less administrative work is involved with delegated credentialing: less paperwork, fewer delays, and more transparency.
  • It provides greater authority over revenue cycles: Forecasting and managing revenue cycles becomes a smoother sail, not a stormy voyage, towards financial stability when there is a predictable, streamlined credentialing process. This relates to speed, but generally, the quicker your providers receive their credentials, the sooner they can start charging for their services and taking payments. The sooner the provider group can start turning a profit, the better.

Getting Value From Assigned Credentials

The method that Medallion uses for delegated credentialing is simple. How we can assist is as follows:

  • Our top priority is meeting your needs. To begin with, ascertain your existing terrain. How many suppliers are you bringing on board? How long does it take to get credentials on average? With Medallion's scalability in mind, you can grow your business without adding more employees. You can save up to 78% of your administrative task time by streamlining the process of submitting multiple online or paper applications with an effective workflow.
  • Working with a skilled group of people: Choose a knowledgeable CVO if you are considering outsourcing. Experience counts. With Medallion, you can rely on a team with extensive experience in credentialing, carrying out tasks that yield results, producing 99.5% accurate verifications using a cutting-edge API, and doing all this from a user-friendly, contemporary platform.
  • You will always know how regulations change: Credentialing regulations can be complicated. It is critical to keep up with regulations, whether NCQA guidelines or CMS requirements. Additionally, the process can go faster if you hold a certification like NCQA, which Medallion possesses.
  • Everything will be centrally located for your convenience: Maintain centralization of the credentialing process, whether you handle it internally or through outsourcing. The best method for preventing errors and duplication is this. Throughout the credentialing verification process, Medallion gives you complete visibility into your provider data, enabling you always to access the appropriate information when needed.
  • Your account will never have a date: The medical field is constantly changing. We check your processes regularly to make sure they are up to date. A centralized operation eliminates all common issues brought about by disjointed workflows.

The final word is that providers can spend more time with patients if they spend less on administrative duties like credentialing. There are also fewer claim denials with quicker credentialing. It benefits both parties.

Make Change A Priority, Or You Will Lose In The Long Run

The healthcare industry is changing quickly. Relying on old-fashioned techniques could cause you to stay caught up, but being aware of delegated credentialing and how your company can use it to its advantage could be your key to success. This method aims to improve efficiency and quality rather than just speed. Adopting well-informed modifications can distinguish you in an area where accuracy is paramount. Are you prepared to alter? Please learn more about how Medallion can assist and our delegated credentialing consulting solutions.


The healthcare scene is quickly developing, and keeping up to date with these progressions is urgent for the outcome of healthcare organizations. Designated credentialing arises as a critical system in this evolution, giving a streamlined process that significantly influences the productivity of provider onboarding and reimbursement processes. By embracing assigned credentialing, healthcare organizations can oversee their revenue cycles, lessen authoritative weights, and spotlight more on conveying quality patient care. This shift improves operational productivity and guarantees financial maintainability in a severe and complex healthcare environment. As the business advances, embracing creative methodologies like appointed credentialing will be indispensable for flourishing ahead.

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