CAQH plus CertifyOS: A Collaborative Model for Modern Provider Data Management

The healthcare industry simply cannot operate efficiently when provider information is fragmented, out-of-date, or siloed. Without appropriate Provider Data Management (PDM), health plans, systems, and patients face major failures:

• Patient Access: Patients can't find available providers for care.
• Financial Impact: Providers don't get paid accurately or on time.
• Regulatory Risk: Systems fail to ensure proper licensing and credentialing.
• Operational Drag: Payers are inundated with piles of messy, inaccurate data.

Provider data is the linchpin of so many core functions, including:

• Credentialing
• Network Management & Adequacy
• Directories
• Roster Maintenance
• Enrollment
• Compliance

This is why the combined work of CAQH (the Council for Affordable Quality Healthcare) and CertifyOS has become so central. CAQH’s large, trusted repository for provider credentials, rosters, directory information, and more provides the data infrastructure for provider management. At the same time, CertifyOS’s modern platform is rising to fill the gaps left by traditional systems, offering continuous updates, automation, integration, and scalable infrastructure. 

Are CertifyOS and CAQH Competitors?

Over the years, we’ve had many people ask us if we compete with CAQH. Our answer is an ardent no. In fact, just the opposite is true: CertifyOS and CAQH are highly complementary. The broad adoption of CAQH’s trusted, standardized workflows enables CertifyOS’s platform to deliver agility, automation, and integration that enhances provider data management (PDM) as a whole.

Insights from the Blueprint Summit

In the spring of 2025, CertifyOS hosted its first Blueprint Summit, a conference focused on the future of provider data management in healthcare. Sarah Ahmad, the CEO of CAQH, joined us at the summit to share her insights on the future of PDM. At the conference, Ms. Ahmad explained that CAQH has calculated the administrative burden on payers and systems for PDM. It’s massive — and growing every day.

Only through intentional, coordinated management can the system begin to chip away at that burden and find real, manageable solutions. That’s why CertifyOS and CAQH have worked so hard to forge a complementary relationship, one that allows both businesses to do what they do best to support the entire PDM system as a whole.

What Does CAQH Bring to the Table?

CAQH has built a Provider Data Portal at a significant scale. It includes credentialing, roster, and directory modules that serve millions of provider records, spanning all 50 states (including complex state-specific credentialing forms). Their data is widely adopted by health plans.

In short, CAQH provides a standardized, widely trusted foundation for provider identity, credentials, and data sharing, enabling providers to enter data once, motivate sharing with multiple health plans, and reduce redundant data entry. For payers and hospital systems, this means less friction, fewer duplicate applications, and more confidence in data completeness.

CAQH is comprehensive, but it is facing emerging challenges. One challenge is the pace of change in provider relationships. For example, new practices, locations, affiliations, and telehealth venues are constantly popping up, driving the need for continuous updates beyond quarterly attestations. This is where platforms like CertifyOS can add value.

What Does CertifyOS Do?

The CertifyOS platform leverages CAQH provider data to streamline PDM for payers. As CAQH aggregates large volumes of provider data and standardizes it, CertifyOS focuses on automating the ongoing workflows, honing in on the areas that tend to cause problems for payers, healthcare systems, and providers.

For example, CertifyOS’s platform has continuous updates to help eradicate manual, error-prone processes. Additionally, CertifyOS’s integrations enable auto-rostering in CAQH, eliminating some of the administrative burden. Via those integrations and many others, CertifyOS provides continuous data updates to administrators, notifying them of any changes.

The capability to take provider-recorded data (whether it’s from CAQH or elsewhere) and continuously update and check it is crucial. Traditional models update data at regular intervals — perhaps every 120 days — through manual roster submissions. This may have worked in the past, but in today’s fast-paced, rapidly changing healthcare environment, it isn’t sufficient. CertifyOS fills that gap by continuously monitoring changes and providing real-time updates, enabling payers to respond more quickly to network changes, compliance events, or provider status changes.

How CertifyOS and CAQH Work Hand-in-Hand

The entire PDM ecosystem offers many ways in which CAQH and CertifyOS complement each other to streamline processes and reduce administrative burden. This starts when a provider completes a CAQH profile and CAQH verifies credentials, licenses, sanctions, and more. Once that provider is in the CAQH system, CertifyOS retrieves the profile via its API and auto-rosters the provider into relevant payer networks or delegated groups. If the provider changes practice location or gains a new certification, CertifyOS detects the change and updates CAQH or the roster as needed.

CertifyOS also supplements CAQH’s updates by continuously monitoring provider status (licenses, sanctions, NPDB events) and feeding alerts. When changes occur to a provider's status such as a new location or affiliation), CertifyOS updates plan rosters via CAQH or directly to the payers.

Why Collaboration, Not Competition, is Key

Using both systems means fewer vendor silos, reduced data hand-offs, lower error risk, and faster speed to value. By leveraging CAQH's foundation while adding CertifyOS's continuous automation, organizations can ensure that provider data workflows feed into the standard repository, avoid data duplication, and maintain consistency across the entire payer ecosystem, ultimately leading to a faster, more streamlined PDM process.