Synergy - September/October 2014 - 27

managed care connections

Delegated Credentialing in Managed Care
continued from page 19

MCO must take corrective action with
the delegated entity. This may simply be
informing the delegate of updates in NCQA
standards that need to be reflected in their
policies. If it is something more critical, such
as missing verification elements or expired
credentials, more serious actions may occur.
The files processed by a delegated entity
are viewed by NCQA in the same manner
as if they were processed by the MCO, so
any mistakes made by the delegate are also
the mistakes of the health plan and may
impact its accreditation status. Similar to the
pre-assessment process, an onsite visit is not
required for the annual oversight review,
and it is up to the discretion of the MCO
to make that determination based on its
experience with the delegated entity.
While diligent oversight of a delegate's
activities by the MCO is critical, there are
other steps to also be considered by both

A provider organization or CVO may have
delegated agreements with multiple health
plans and each agreement may have different
obligations based on each MCO's own
policies, procedures, and requirements.
parties to ensure a successful delegation
experience. It is important that everyone
involved with the delegation process
understands what is required per the
agreement so there are no surprises later
on. A provider organization or CVO may
have delegated agreements with multiple
health plans and each agreement may have
different obligations based on each MCO's
own policies, procedures, and requirements.

In addition, keep the communication
lines open between both parties regarding
changes in standards, policies, and
procedures or upcoming audit dates and
timelines. This collaborative approach will
make it a win-win relationship for everyone
involved and impacted, including the
MCO, the delegated entity, practitioners,
and patients. ■

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Synergy - September/October 2014

Table of Contents for the Digital Edition of Synergy - September/October 2014

Contents
Synergy - September/October 2014 - Intro
Synergy - September/October 2014 - Cover1
Synergy - September/October 2014 - Cover2
Synergy - September/October 2014 - 1
Synergy - September/October 2014 - Contents
Synergy - September/October 2014 - 3
Synergy - September/October 2014 - 4
Synergy - September/October 2014 - 5
Synergy - September/October 2014 - 6
Synergy - September/October 2014 - 7
Synergy - September/October 2014 - 8
Synergy - September/October 2014 - 9
Synergy - September/October 2014 - 10
Synergy - September/October 2014 - 11
Synergy - September/October 2014 - 12
Synergy - September/October 2014 - 13
Synergy - September/October 2014 - 14
Synergy - September/October 2014 - 15
Synergy - September/October 2014 - 16
Synergy - September/October 2014 - 17
Synergy - September/October 2014 - 18
Synergy - September/October 2014 - 19
Synergy - September/October 2014 - 20
Synergy - September/October 2014 - 21
Synergy - September/October 2014 - 22
Synergy - September/October 2014 - 23
Synergy - September/October 2014 - 24
Synergy - September/October 2014 - 25
Synergy - September/October 2014 - 26
Synergy - September/October 2014 - 27
Synergy - September/October 2014 - 28
Synergy - September/October 2014 - 29
Synergy - September/October 2014 - 30
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