Managed Care & Delegated Credentialing
The processes that keep health plan credentialing compliant, consistent, and audit ready.
Delegated Credentialing Governance
Build clear delegation structures, oversight responsibilities, reporting pathways and accountability aligned with NCQA requirements.
Delegation Oversight & Auditing
Develop pre-delegation assessments, annual audits, corrective action processes, reporting and ongoing delegated entity oversight.
Initial & Recredentialing
Design compliant workflows for application review, primary source verifications, decision-making, and timely recredentialing.
Practitioner Data & Operational Workflows
Strengthen roster management, handoffs, and credentialing status reporting for operational efficiency.
NCQA Policies & Procedures
Align credentialing policies, procedures, timeframes, and documentation with NCQA standards and operational practice.
Ongoing Monitoring
Create consistent pathways for review, documentation, escalations, and evaluation for continuous compliance.