Delegated Credentialing

Delegated credentialing occurs when a health care entity gives another health care entity the authority to credential its health care practitioners (e.g., a preferred provider organization [PPO] delegates its credentialing to a hospital). Delegated credentialing goes beyond credentials verification, because the delegated health care entity (e.g., the hospital) is responsible for evaluating practitioners' qualifications and making credentialing decisions on behalf of the delegating health care entity (e.g., the PPO).

In a delegated credentialing arrangement, the health care entity that delegates its credentialing responsibilities (e.g., the PPO) is not considered part of the credentialing process and is prohibited from receiving NPDB query results. In contrast, a health care entity that uses an authorized agent to query on its behalf still retains responsibility for credentialing its practitioners.

Therefore, if a PPO or similar health care entity delegates its credentialing to a hospital or other health care entity and also designates the hospital as its authorized agent, the following apply:

• An NPDB query submitted by the hospital as a delegate cannot be shared with the PPO because the PPO is neither responsible for the credentialing nor part of the decision-making process. The query, in this instance, is for the exclusive use by the hospital in credentialing.
• In contrast, if an NPDB query is submitted by the hospital as an authorized agent on behalf of the PPO, the query response is for the PPO's use and the hospital is prohibited from using the same query as part of its credentialing.

A hospital may not delegate its responsibility to query the NPDB. A hospital's mandatory query must be submitted to the NPDB either directly by the hospital or through an authorized agent.