PROVIDER ELIGIBILITY
Network inclusion eligibility, automated at intake.
Determine provider eligibility against your plan's network inclusion criteria — specialty, geography, panel status, Medicare/Medicaid acceptance — at intake, before applications proceed. CertifyOS replaces manual eligibility screening with intelligent intake forms, hard-stop logic, and dynamic form routing built into the provider portal.
- Multi-layer eligibility checks: specialty, geography, panel status, Medicare/Medicaid acceptance
- Configurable hard-stop logic with custom messaging — stop processing ineligible applications
- Automated contract delivery to eligible providers + direct handoff to credentialing
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See network inclusion eligibility screening built into the provider portal.
Trusted by leading health plans, digital health companies, and provider networks
Network inclusion eligibility, at scale
- 5+eligibility layers — specialty, geography, panel status, Medicare/Medicaid acceptance, and more
- 0ineligible applications processed downstream
- Real-timepanel status validation with API integration to payer systems
- 8of the 10 publicly listed US Health Plans are CertifyOS Clients.
THE PROBLEM
Health plans waste cycles processing applications from ineligible providers.
Providers apply to networks where they don't qualify. Plans process the application, send it through credentialing, and reject it weeks later — burning ops cycles, frustrating providers, and creating communication overhead.
CertifyOS eliminates the rework by screening eligibility at intake. Multi-layer rule checks — specialty, geography, panel status, Medicare/Medicaid acceptance — embedded in the application flow, with hard-stop logic and custom messaging for ineligible providers. Only qualified applications make it to credentialing.
Five layers of network inclusion eligibility.
Network inclusion criteria
Configure plan-specific eligibility rules — specialty, geography, panel status, license type, Medicare/Medicaid acceptance, and more — embedded directly into the intake form.
Hard-stop logic
Disqualifying responses trigger configurable hard stops with custom messaging. Ineligible providers get clear, immediate feedback. Eligible providers proceed to credentialing.
Conditional form logic
Dynamic field visibility, conditional question routing, auto-population from prior responses, and dropdown filtering based on earlier selections. Intelligent forms that adapt to each applicant.
Panel status validation
Tier 1: static hard stops for fixed eligibility rules. Tier 2: real-time API integration with payer systems for dynamic panel status (open/closed) validation.
Automated handoff
Automated contract delivery to eligible providers at end of workflow. Eligibility confirmation triggers downstream credentialing and contracting workflows on the CertifyOS platform.
CertifyOS network eligibility vs. manual screening.
CertifyOS
- Eligibility checked at intake, before applications proceed
- Multi-layer rule logic: specialty + geography + panel status + payer mix
- Hard-stop logic with custom messaging for ineligible providers
- Automated contract delivery to eligible providers
- Direct handoff to credentialing post-eligibility
Manual screening
- Eligibility checked manually, weeks into the application
- One-dimensional rule checks (often just specialty)
- Ineligible providers rejected late, with manual outreach
- Contract delivery via email and follow-up
- Manual handoff between intake and credentialing
FROM OUR CUSTOMERS
“Most eligibility rework happens after the application is already in the system. CertifyOS moves the screening upstream — to the intake form itself — so plans only process applications from providers who actually qualify for the network.”
— CertifyOS Network Inclusion Team