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Presented by: Jennifer Stoppel Delegation Compliance Specialist Medica Health Plan

Presented by: Jennifer Stoppel Delegation Compliance Specialist Medica Health Plan. Delegation. What is it? Misconceptions Risks Efficiencies Partnership/relationship Process improvement. Delegation continued:. Pre-delegation process Criteria

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Presented by: Jennifer Stoppel Delegation Compliance Specialist Medica Health Plan

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  1. 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

  4. Delegation Approved • Oversight of the delegation arrangement • NCQA standards

  5. 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

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

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

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