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Delegated Credentialing

Table of Contents:. DefinitionDelegated CredentialingBenefitsInitial AssessmentDelegated Credentialing AgreementOngoing Compliance. Delegated Credentialing. Definition:Engaging another organization to perform the credentialing function on your behalf.. L

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Delegated Credentialing

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    1. Delegated Credentialing Joann Willyerd Provider Credentialing & Compliance

    2. Table of Contents: Definition Delegated Credentialing Benefits Initial Assessment Delegated Credentialing Agreement Ongoing Compliance

    3. Delegated Credentialing Definition: Engaging another organization to perform the credentialing function on your behalf.

    4. L&I may delegate credentialing activities to: Medical group(s) and Clinics Physician Organizations Credentials Verification Organizations (CVO’s) Other organizations that employ and/or contract with practitioners/providers.

    5. L&I Delegation Requirements Tasks Delegated: Organizations must have a credentialing program that continuously meets the department’s requirements. L&I’s Responsibility: L&I retains the right to review, approve, or deny any practitioner who has been credentialed by the delegated entity.

    6. Benefits of Delegation Recognizes other organization’s credentialing process Applications processing and credentialing are done quicker Credentialed, approved, and contracted applicants may enroll in the network quicker

    7. Initial Assessment of Delegated Entity L&I will review the entity’s: Credentialing Policy Credential File Decision making process Appeal process Ongoing monitoring

    8. Delegation agreement(s) should: Be mutually agreed upon Identify delegated functions and responsibilities Identify reporting requirements Identify oversight responsibilities Describe corrective action and termination of the delegation agreement 10). 10).

    9. Delegation agreement(s) should also: Enable L&I to retain decision making authority Describe remedies including termination for non-compliance Adhere to contractual requirements Review annually to ensure ongoing compliance

    10. Ongoing Compliance Quarterly the organization will provide a summary of credentialing program activities L&I will do an annual onsite review of the delegate’s credentialing program

    11. Confidentiality of Information The delegated entity must comply with collection, use, disclosure, security, access, and amendment requirements of Health Insurance Portability and Accountability Act (HIPAA) as amended.

    12. Thank you! Questions?

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