What Is Provider Intelligence?

How superior data helps health organizations optimize their provider network management processes and meet growing patient demand

Accurate, accessible provider data is critical for health organizations when it comes to building high-quality networks and ensuring high-quality care—but it doesn’t come easy.

The costs of manually collecting, processing, and updating provider data can siphon valuable time and resources from already strapped teams. In fact, it’s estimated health organizations spend 20% of their working hours—or around $2.76 billion each year—on provider data management (PDM). 

Meanwhile, the U.S. patient population is expected to rise at a compound annual growth rate of 17.8%. That means processing provider data quickly and effectively will become increasingly essential as health organizations look to scale their networks and keep up with patient demand.

So, how can they ensure their administrative force is up to the task?

Recent trends suggest that it’s not enough to simply manage provider networks and provider data using manual legacy processes. Rather, the industry’s future lies in proactive, tech-forward solutions that automate key tasks and use real-time provider insights to drive greater accuracy and efficiency. We call this “provider intelligence.”

Where legacy provider network management falls short

Provider network management refers to the tools and methods a health organization uses to compile and maintain provider data to ensure its network is up to date and in line with the latest regulatory requirements.

However, provider network management can take many different forms, and approaches vary widely from team to team. What’s more, there are no official criteria or unifying standards in place to define what makes provider network and provider data management strategies successful.

The result is a host of isolated products that claim to optimize provider network processes and data management while still relying on outdated, inefficient workflows.

That means health organizations are often left with highly manual systems:

• Verifying provider credentials through individual emails and phone calls
• Non-responsive providers not responding to requests for missing or incorrect information
• Significant time and resources spent to validate provider directory data
• Enrolling providers and updating provider directories to reflect roster changes

Not only do these manual tasks cause needless delays and hold up care, they lead to avoidable errors, inconsistencies, and information gaps that can pose significant problems during an audit. They also make it difficult for health organizations to grow their network, since onboarding new providers introduces months of additional busywork.

Fortunately, provider intelligence platforms have emerged to solve these challenges, offering automated workflows that promise greater speed and precision.

The value of provider intelligence

Simply put, provider intelligence platforms like CertifyOS take network management to the next level and streamline many of the administrative tasks involved.

We use API-first technology to build a comprehensive provider databank and power a fully automated infrastructure. That means we can connect to hundreds of primary sources and pull verified provider data in a matter of seconds.

Unlike legacy network management systems, provider intelligence is:

• Automated: With APIs handling data collection and verification, essential tasks like licensing and credentialing can be completed with just a few clicks and zero paperwork.
  
  
• Integrated: Required steps are built into every application, and forms can be auto-filled with the necessary provider data, eliminating guesswork and rework.
  
  
• Efficient: Real-time data and proactive workflows mean months-long administrative timelines can be cut down to days or minutes.
  
  
• Accurate: Verified data points are pulled straight from the source, with automatic updates to provider directories.
  
  
• Transparent: Networks are monitored on an ongoing basis, with instant alerts notifying teams of any issue or change in status.
  
  
• Accessible: All data and documents are consolidated on a centralized, intuitive dashboard, making it easy to run reports and prepare for annual audits.
  
  

For instance, CertifyOS's centralized provider databank allows health networks to reduce the amount of information they require from 13 pages to two. It can also increase application volume by over 50% and reduce credentialing costs by up to 90%.

While legacy network management systems do the bare minimum of storing and organizing provider data, provider intelligence solutions offer proprietary endpoints, unique perspectives, and unparalleled visibility—which health organizations can use to grow their networks with confidence.

What sets CertifyOS apart

CertifyOS’s intelligent approach to provider data optimizes administrative tasks across the board. For example, our fully NCQA-certified, one-click credentialing solution offers:

• Broader insights, with real-time, automated access to over 1,600 provider data points
  
  
• Flexible configurations, with tooling that can be customized to an organization’s precise specifications and pre-set alerts that align with their policies and procedures
  
  
• Continuous monitoring, with live flags whenever a record needs further review, so provider networks can stay effortlessly compliant between credentialing cycles
  
  
• A single source of truth to manage provider documents and export detailed rosters in custom formats
  
  

We also offer simple, integrated licensing workflows that are pre-built by state and provider type and streamlined enrollment processes with plan-level visibility and delegated credentialing support—so health organizations can not only scale with ease, but get providers in-network and reimbursed for services faster.

Discover the power of provider intelligence

Want to learn what CertifyOS’s provider intelligence can do for your healthcare organization?

Reach out to sales@certifyos.com to chat with a member of our team—or request a demo to see our platform in action.