Glossary
Pre-Delegation Audit
A health plan's review of an organization's credentialing program before allowing it to perform credentialing on the plan's behalf.
A pre-delegation audit is the evaluation a payer conducts before agreeing to a delegated credentialing arrangement, examining the would-be delegate's policies, files, and processes to confirm they meet the plan's standards. Auditors commonly look for alignment with recognized frameworks such as NCQA and verify that the delegate can reliably perform credentialing at the required level. Passing this audit is a prerequisite for the plan to hand over decision-making authority.