Oscar Health achieved 29% annual cost savings with CertifyOS

From manual credentialing to a real-time, integrated platform

Oscar Health partnered with CertifyOS to replace manual credentialing with a real-time, primary-source-integrated platform — unlocking 29% annual cost savings and $733K in total annual savings.

The challenge: manual processes, compliance risk, unreliable data

Oscar Health faced significant challenges in their credentialing process:

• Manual delays — manual credentialing caused delays, hindering expansion.
• Error prone — managing the scale of credentialing and regulatory updates manually led to errors.
• Data issues — unstructured data made reporting difficult.
• Growth detractor — without integration with primary sources, every stage of credentialing required manual verification, creating lengthy turnaround times and administrative inefficiencies.
• Compliance challenges — Oscar's manual infrastructure couldn't ensure timely, accurate compliance with NCQA and state policies. Audits were cumbersome, and expired licenses, DEA certificates, and board certifications were slipping into the network. Limited monitoring increased the risk of including providers with expired credentials or sanctions, exposing Oscar to liability.
• Inaccurate and unreliable data — without scalable infrastructure, maintaining accurate provider data was cumbersome, leading to inaccuracies in directories and denied claims.

The solution: real-time credentialing, automated data exchange, configurable workflows

Oscar Health partnered with CertifyOS for real-time credentialing and verification, automated network data exchange, and configurable workflows to reduce costs. The implementation spanned three pillars:

• Foundational provider data infrastructure — CertifyOS implemented real-time credentialing, drastically reducing turnaround times and enabling Oscar to scale networks quickly. Primary-source integrations and data customization added efficiency to downstream systems.
• Innovative network integration — on-demand file verification reduced verification times from weeks to minutes, improving accuracy and transparency. An intelligent monitoring system flagged problematic providers in real time.
• Comprehensive workflow — CertifyOS's programmatic logic reduced Oscar's operating expenses by enabling configurable workflows, automated recredentialing timelines, and integrated credentialing committees.

The impact: 29% cost savings, $733K annually

• Reduced credentialing TATs to 3 days from 29.4.
• Monitored 85,000+ providers and fully credentialed 38,000+.
• Saved $150,000 annually in administrative costs — contributing to $733K total annual savings.
• Decreased duplicate provider issues, reduced wrongful file inclusion and audit fees, and cut manual, error-prone tasks.
• Enabled focus on strategic growth opportunities.

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