If you’ve spent any time in healthcare administration, you’ve heard both terms. But the practical difference between delegated and non-delegated credentialing (aka provider enrollment)—and what it means for your organization’s operations and revenue—isn’t always clearly explained.
Here’s a straightforward breakdown.
Non-Delegated Credentialing: How most organizations start
In a non-delegated credentialing arrangement, the health plan handles all credentialing functions itself. When you want to add a provider to your panel, you submit their enrollment application and supporting documentation to the payer, and then you wait. You do this for each payer, using each payers form and requirements, and do that over and over again
The payer then reviews the application, performs primary source verification, and makes an enrollment decision. Depending on the payer and current volume, this process can take anywhere from 60 to 180 days.
During that time, your provider may be working but not yet billable to that payer. Every day of that gap is lost revenue.
Delegated Credentialing: Taking the process in-house
In delegated credentialing, the health plan authorizes your organization to perform credentialing and re-credentialing functions on its behalf. Your team verifies credentials, your committee makes decisions, and you notify the payer of the outcome.
The health plan still sets the standards your program must meet and conducts periodic oversight audits. But day-to-day, credentialing happens on your timeline, not theirs.
Side-by-side comparison
Non-Delegated:
- Health plan credentials providers
- Typical timeline: 60–180+ days
- Lower upfront burden
- Minimal control over timeline
- No payer audits
- Best for small or stable organizations
Delegated:
- Your organization credentials providers
- Typical timeline: 5–30 days
- Higher upfront responsibility
- High control over timeline
- Annual or semi-annual oversight audits
- Best for growing organizations or organizations with higher turn over
The real cost of non-delegated credentialing
A medical group adding 20 providers annually with 90-day credentialing delays can experience millions of dollars in delayed revenue. Delegated credentialing compresses timelines and gives organizations more control over provider onboarding.
What it takes to move from non-delegated to delegated
- Written credentialing policies meeting NCQA standards
- A functioning credentialing committee
- Consistent primary source verification
- Clean, auditable provider files
- Timely credentialing and re-credentialing processes
Which is right for your organization?
Consider remaining non-delegated if:
- You credential fewer than 100 providers
- Provider turnover is low
- You lack staff capacity for delegation oversight
Consider delegated credentialing if:
- You credential 100+ providers
- Onboarding delays affect revenue
- You want more operational control
- You can investing in a credentialing program
Ready to explore delegation?
If you’re unsure whether your organization is a candidate for delegated credentialing, Delegated Credentialing Pros can help assess your readiness and build a roadmap to delegation success.
