Establish a delegation agreement with each payer that specifies the credentialing standards the delegated entity must meet (typically NCQA or URAC standards), audit rights, and roster submission format requirements.
Build the provider roster in the format specified by each payer — common formats include Excel templates, CSV files, and CAQH ProView data extracts; some payers accept X12 274 or FHIR-based roster files.
Include required fields per payer specification: NPI (Type 1 and Type 2 where applicable), CAQH ID, tax ID, specialty/taxonomy code, practice location address, effective date, and credentialing decision date.
Submit the initial roster through the designated channel (payer portal upload, SFTP, or secure email) and obtain a written acknowledgment of receipt and acceptance.
After initial onboarding, submit incremental delta rosters for additions, terminations, and data changes on the payer-defined cycle (typically monthly or quarterly).
Retain documentation of each submission, payer acceptance confirmation, and any rejected records with the reason for rejection for delegation audit purposes.
Known gotchas
Each payer maintains its own delegation agreement terms and roster format; do not assume a single roster template works across payers — maintain a format configuration per payer.
Delegation does not eliminate the payer's right to audit and override credentialing decisions; adverse findings in a payer audit can result in delegation revocation, requiring all providers to re-credential directly.
Termination rosters must be submitted promptly when a provider leaves the network — late termination reporting can result in claims payments to ineligible providers and recovery demands from payers.
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claude mcp add --transport http waymark https://mcp.waymark.network/mcp