Delegates
Becoming a delegated group
If your organization manages its own credentialing and wants to do so officially on behalf of Blue Cross NC, delegated status may be the right next step. Delegation allows you to take the lead while we stay closely aligned and accountable together.
Explore how delegation works, what it takes to get started, and how we support ongoing compliance.
Delegation is when Blue Cross NC authorizes your organization to perform certain functions, such as credentialing, on our behalf.
You operate as a delegate, and we remain accountable to regulatory agencies for oversight and performance. It’s a shared responsibility built on trust, transparency, and consistent standards.
Delegates must meet and maintain standards established by:
- Blue Cross NC
- North Carolina Department of Insurance (NCDOI)
- National Committee on Quality Assurance (NCQA)
- Centers for Medicare & Medicaid Services (CMS)
These standards help ensure quality, consistency, and regulatory compliance across our network.
Before granting delegated status, we complete a pre-delegation audit. This review helps confirm that your processes align with required standards and typically includes:
- Credentialing workflows
- Committee structure and policies
- Appeals and ongoing monitoring processes
- Data accuracy and audit practices
We’ll guide you through what’s needed so there are no surprises along the way.
Once approved, delegates are expected to stay compliant with all applicable standards. If issues arise, we’ll work with you to address them. Ongoing non-compliance, however, may result in revocation of delegated status.
Our goal is long-term partnership, and we’re committed to supporting you in meeting expectations.