Fairview System Credentialing Office
What is Delegated Credentialing?
- Delegated credentialing is a formal process by which an organization gives another entity the authority to perform credentialing functions on its behalf.
- Practitioners covered under Fairview’s delegated credentialing contracts with health plans do not have to submit credentialing paperwork to health plans. Practitioners get credentialed at Fairview and then Fairview submits the appropriate credentialing paperwork to the health plans. Practitioners are accepted into health plan provider panels the date of Fairview’s credentialing approval. A health plan may decide to credential the practitioner via their process instead of Fairview’s but this is a rare and usually occurs if there is something in the practitioner’s history that raises concern for the health plan.
- By participating in delegated credentialing agreements, Fairview System Credentialing is required to meet NCQA (National Committee for Quality Assurance) credentialing standards. NCQA is the accreditation organization for health plans. In addition, health plans have a responsibility to audit Fairview’s credentialing policies and processes annually. Fairview System Credentialing also participates in the credentialing portion of a health plan’s NCQA accreditation survey. Fairview System Credentialing is an NCQA-Certified Credentials Verification Organization (CVO).
- Eliminates duplication and reduces costs because practitioners and their clinics do not have to complete a credentialing application for each health plan.
- Enhances third party payer reimbursement for contracted entities because health plans accept Fairview's approval date(s) and primary source verification (versus waiting to go through an approval process by each health plan).
Contracted Practitioner Groups Included in Fairview’s Delegated Credentialing Contracts*
- All Fairview-employed licensed independent practitioners such as physicians, nurse practitioners, physician assistants, nurse midwives, etc.
- Pathology groups providing services at a Fairview entity
- Licensed independent practitioners employed by University of Minnesota Physicians (UMP)
- Licensed independent practitioners contracted by Fairview to provide services at a Fairview entity
- Members of Fairview Physician Associates (FPA)
- Members of Behavioral Healthcare Providers (BHP)
Contracted Health Plans*
- Araz Group/America's PPO
- First Health
- Metropolitan Health Plan
- South Country Health Alliance
- UCare Minnesota
- WEA Trust
- Wisconsin Physician Services
*Please note: Not all contracted practitioner groups are delegated with all contracted health plans.