What is Delegated Entity?

Delegted Entity Definition

Delegated Entities represent a shift in operational responsibility from the payer to the provider organization. For Payer Ops, delegation can significantly speed up the on-boarding process, as the entity (often an IPA or large health system) manages the primary source verification of its own providers. However, for C-level executives, delegation introduces significant oversight risk. The payer remains legally responsible for the accuracy of the data and the quality of the providers. This requires a robust "delegation oversight" program, including regular audits of the entity's files and processes to ensure they meet NCQA or URAC standards.

FAQs

What is the primary benefit of "Delegated Credentialing"?

It allows providers to be added to the network much faster by eliminating the need for the payer to re-verify information already vetted by the entity.

What are the risks of using a Delegated Entity?

If the entity has poor data governance, the payer’s directory and claims systems will become populated with inaccurate or outdated provider information.

How is a Delegated Entity monitored?

Monitoring usually involves annual audits where the payer reviews a sample of the entity’s credentialing files to ensure compliance with plan standards.