The Delegated Credentialing & Primary-Source Verification Engine assembles a payer-audit-defensible file per provider — every primary source verified, every 30-day sanction check run, every NCQA element gate-checked — so new clinicians go from hire to billable in days instead of months.
Every physician, nurse practitioner, therapist, and PA must be credentialed before they can be reimbursed by a health plan. The process is voluminous, deadline-driven, and unforgiving — education, training, licensure, board certification, DEA registration, work history, malpractice history, and sanction status must be verified against the primary source. When it slips, the provider sits idle: industry data puts the loss at roughly $7,500 per provider per month, with 67% of medical groups reporting 60–90 day onboarding delays.
The compliance surface just got harder. NCQA's credentialing standard, effective for surveys on or after July 1, 2025, now requires monthly license-expiration tracking and 30-day checks of OIG, SAM.gov, Medicare/Medicaid exclusion, and state-board sanctions — with adverse findings escalated to a peer-review body. On the liability side, at least 28 states recognize 'negligent credentialing' as a distinct tort; an Illinois appellate court upheld a $7.7M verdict for it (Frigo v. Silver Cross).
Most groups run this by hand, from memory, with a spreadsheet and an overwhelmed office manager. That is exactly where compliance gaps hide.
We do not summarize the standard and hope. Every file is scored against a versioned rule pack tied to the exact text of NCQA's credentialing standard (effective July 1, 2025). These are the provisions each file is held to.
Education, training, licensure, board certification, DEA registration, work history, malpractice history, and sanction status — all verified against the primary source within 120 days (accreditation) or 90 days (CVO certification).
Monthly checks of OIG, SAM.gov, Medicare/Medicaid exclusion, and state-board sanctions — with adverse findings escalated to the client's credentialing committee within 5 business days.
License-expiration dates tracked and verified monthly; any lapse triggers immediate notification and suspension of billing privileges until reinstated.
Every file built to pass a delegated-credentialing payer audit: complete documentation trail, signed attestations, and a clear chain of custody from primary source to committee decision.
All verification results compiled into a single, organized file with an executive summary, exception log, and recommendation — ready for the client's credentialing committee to review and vote.
Recredentialing every 36 months (or per payer requirement) with the same primary-source rigor; monitoring continues in the interim.
AI extracts and drafts. Deterministic rules — running as code, outside the model — decide what is complete. A certified credentialing specialist (CPCS/CPMSM) signs every release. That order is never reversed.
Upload the provider roster and CAQH/application. We return a free completeness read: which primary sources are verified, which are missing, and what monitoring is needed.
As your authorized clerical agent, we query every primary source — medical boards, DEA, NPDB, OIG, SAM, state boards, education institutions, training programs, and prior employers — and collect verified data.
All verified data is compiled into an NCQA-compliant file with field-locked templates — no legal opinions, no invented facts.
Every NCQA element is checked: all primary sources verified, sanctions screened, license tracked, file organized. Any failure blocks release.
A certified credentialing specialist (CPCS/CPMSM) reviews the exception queue and signs the release. High-risk or adverse findings route to attorney review first.
You receive the file: verification report, source evidence, committee-ready summary, and ongoing 30-day monitoring alerts. The provider is ready for committee review and billing.
The deliverable is completeness itself — every NCQA element and primary source accounted for or explicitly exception-coded. Nothing is left implicit.
The gates that decide completeness are code, not a model's opinion. A drafting error cannot slip past a regulatory requirement.
We prepare documentation and run searches as your clerical agent. We never make clinical decisions, grant privileges, or contact providers directly.
Simple, predictable, and aligned with a documentation standard — not a cut of any recovery.
Start with a free Credentialing Gap Scan. Send your provider roster and CAQH/application and we'll return a completeness read against every NCQA element.
Documentation-completeness service · not legal advice · the provider group keeps all clinical decisions.