1. Delegation Compliance Specialist
Presented by:
Jennifer Stoppel
Delegation Compliance Specialist
Medica Health Plan

2. Delegation What is it? Misconceptions Risks Efficiencies
Partnership/relationship
Process improvement

3. Delegation continued:
Pre-delegation process
Criteria
Completion of pre-delegation assessment form
Evaluate policies, procedures, credentialing plan, etc.
On-site file audit

5. Delegation Approved Oversight of the delegation arrangement
NCQA standards

7. Responsibilities Health Plan Annual on site audits including:
File review
Policy, procedure, credentialing plan review
Credentialing committee meeting minute review
Interview with credentialing staff
Approval of audit findings, which may include corrective action plan based on committee decision

8. Responsibilities continued
Delegate
Monthly/weekly reports
Ongoing monitoring
Policy updates
Reporting of sanctioned providers
Semi-annual reporting
Participation in annual on-site review

9. Efficiencies Credentialing Collaborative Health plans that participate
Purpose of the collaborative
How the collaborative functions