Credentialing: Considering delegation?

When a payor authorizes an organization to perform credentialing in-house, the process is referred to as delegated credentialing. Delegated credentialing goes beyond credentials verification, because the delegated health care entity is responsible for evaluating practitioners' qualifications and making credentialing decisions on behalf of the payor. In this arrangement, the delegated entity does all the work necessary to complete the credentialing process. However, the payor still has the authority to veto any decision made by the delegated party. 

Note: A delegated credentialing agreement is a separate agreement from a group’s network agreement with Health Net Federal Services, LLC (HNFS).

Pre-Assessment Auditing

Should you meet the preliminary requirements based on your New Delegation Request form submission, HNFS will contact you within 21 days to conduct a pre-assessment audit of your entire credentialing program to ensure it meets HNFS, TRICARE and URAC requirements.

Becoming a Delegated Provider Group

All provider groups who have a credentialing department can submit a New Delegation Request form for a preliminary review and potential recommendation for pre-assessment audit with HNFS to enter in to a delgated credentialing agreement.

Also refer to the "Roster Submissions Guidelines" section of our Credentialing Overview page

Frequently Asked Questions

Find answers to frequently asked questions about delegated credintialing on our FAQ page.