CertifyOS, a provider data intelligence company, has launched a new platform to help payers manage provider data in their network, the company announced last week.
New York City-based CertifyOS serves health plans and digital health companies and is working to streamline access to provider data, whether that’s for provider directories or medical claims. Its new AI-powered platform, called the Provider Hub, takes data from a range of sources — credentialing, directories, claims, rosters, etc. — and cleans it and unifies it into a single file for payers.
The platform integrates directly with downstream systems, such as contracting, directories and claims systems. It identifies when there are gaps in the data and flags issues to help support decision-making. In addition, it continuously monitors provider data and sends alerts on outdated records.
The new Provider Hub is significant because every part of healthcare operations — including payment integrity claims, member experience and provider directories — is impacted by inaccurate provider data, according to Anshul Rathi, founder and CEO of CertifyOS. The healthcare industry spends about $3 billion a year to manually update provider directories.
“What we have today is dozens of provider data teams picking up the phone, calling the providers and maintaining their own system of record. So even within the organization, if a team has up-to-date provider data, it is not transmitted to other parts of the organization,” he said.
“We believe that is one of the biggest causes of irreversible administrative costs in the U.S. healthcare industry,” he continued. “There should be a central hub that is so connected with all these disjointed sources and the providers themselves, that any change by the sources, in the sources or by the providers is reflected in the data source, making it a de facto source of truth. That’s what Certify’s Provider Hub is.”
Rathi added that CertifyOS already has about 30 payer customers for this platform, including national plans and Medicare Advantage plans. However, he declined to name specific customers. Payers pay a fee for the platform, with a subscription on top of that.
The launch of the Provider Hub comes shortly after CertifyOS raised $40 million in Series B funding in June. That funding helped support the creation of this new platform.
Ultimately, CertifyOS aims to “fundamentally change how U.S. healthcare interacts with provider data,” Rathi said.
“The goal is that patients have a great experience,” he noted. “If they go to a doctor, their insurance is accepted, the doctors actually work there, and they don’t have to chase the insurance companies with claims. … That’s a huge part of the patient experience overall with what we are doing. At the same time, we believe that the provider should not be spending their time filling the same application multiple times or getting contracted with multiple payers multiple times.”
Photo: Yuichiro Chino, Getty Images
