What is delegation? Capitation and/or delegation supplement - 2021 Administrative Guide

Delegation is a process that gives another entity the authority to perform specific functions on our behalf. We may delegate:

  1. Medical management.
  2. Credentialing.
  3. Claims.
  4. Complex case management.
  5. Other clinical and administrative functions.

When we delegate any of these responsibilities to you, you are a delegated provider. This is also called a “delegated entity” or “delegate.” We are responsible to external regulatory agencies and other entities for the performance of the delegated activities. To become a delegate, the provider/ACO must be in compliance with our established standards and best practices. To remain a delegate, the provider/ACO must comply with our standards and best practices. If the delegate is non-compliant with our standards and best practices, we may revoke any or all delegated activities.

If you are associated with a delegated medical group, IPA, or other entity, use their office policies and protocols.

This supplement is intended for use by participating physicians, health care providers, facilities and ancillary providers who are delegated for certain UnitedHealthcare activities. This supplement applies to all benefit plans for members whose:

  1. Medical group, IPA, or other care provider performs any of the above functions on behalf of UnitedHealthcare, or
  2. Care provider is a member of an ACO, where the ACO performs any of the above functions on behalf of UnitedHealthcare.