Delegated credentialing is a convenient way to streamline the credentialing process and avoid the need to repeatedly go through a PPO or insurer. Here are some of the pros and cons of delegating credentialing that every dental practice should understand.  

What Is Delegated Credentialing?

Delegated credentialing is a term that refers to a healthcare entity giving another healthcare entity the ability to credential its healthcare providers. For example, this can happen when a PPO gives its credentialing ability to a hospital or another third party like a DSO. While credentials verification is one aspect of delegated credentialing, this goes a step further, as in the example above the hospital would be able to make future credentialing decisions on behalf of the PPO. Once delegated credentialing is in place, the hospital or DSO would be able to take care of credentialing on their own instead of going through the PPO.

The Benefits of Delegated Credentialing

Delegated credentialing gives DSOs, hospitals, and other healthcare organizations the ability to bypass the traditional credentialing process through a PPO. This can radically accelerate the timeline and give them more flexibility throughout the credentialing application process. This is great news for practices that are used to the credentialing practice dragging on for many months.

Because DSOs and hospitals will have the ability to complete credentialing on their own after they have completed the delegated credentialing process, it can also make it much easier to handle things like acquisitions, new practices, and TIN changes. When you can take care of things in-house, it often takes much less time.

The Potential Downsides of Delegated Credentialing

While delegated credentialing can cut down on the amount of time it takes you to complete the credentialing process, it will increase the amount of work that you need to do in your office. You will need to take care of satisfying all credentialing standards, knowing the credentialing policies and procedures and being able to stick to them, meeting all of the reporting requirements of the PPO, having sufficient staff and systems to comply with any audits, and much more. While plenty of dental practices are interested in reaping the benefits of delegated credentialing, they do not want to handle the logistics of the process on their own. As a result, working with a third party to complete the credentialing process on your behalf, like APEX Reimbursement Specialists, can be a great idea.

Improve Your Business with APEX Reimbursement Specialists

Whether you’re interested in revenue optimization or looking for other services to boost your business, APEX Reimbursement Specialists is here to help. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.