Health tech company CertifyOS is launching a new national model for provider credentialing, with several major payers already on board as participants.
The company announced Wednesday that the launch of its National Shared Credentialing Program is designed to significantly streamline the credentialing process, something providers often have to undergo upwards of a dozen times per year. Initial participants in the model include UnitedHealthcare, Cigna and Centene.
The program will eliminate duplicative submissions and establish a standardized process for credentialing across the participating payers, CertifyOS said. It aims to reduce the administrative burden on both payers and providers, while building a key source of provider data.
Anshul Rathi, CEO of CertifyOS, told Fierce Healthcare that the company hosts a conference each year centered on provider data, and the team asked payer clients if they’re competing on improvements in this space. The answer was widely “no,” he said.
That highlights the opportunity here to innovate and drive improvement, he said. Rathi said that between 1.4 million and 2 million providers will complete credentialing through CerifyOS’ platform next year, with plans to launch the platform this fall.
“Today, if you look at the process, every healthcare professional has to go to every single health plan separately and get credentialed,” Rathi said. “We said that was a redundant process.”
“The more provider density, the easier it is going to be for the providers to get in network, and for the plans to manage this process as well,” he said.
In the announcement, CertifyOS said that the U.S. health system spends more than $2 billion per year on provider credentialling, and if that process were unified it could reduce those costs by 75%. It costs plans between $200 and $500 per cycle in credentialing providers, duplicated across the many systems with which they may contract.
Providers, meanwhile, need to submit an average of 17 applications each year to different payers, costing approximately $700 in expenses and time spent on the submissions, per Certify.
Through it platform, health plans offer CertifyOS details on their roster of providers in need of credentialing, and the team administers that work on their behalf, minimizing duplicate outreach and verifying submissions against National Committee for Quality Assurance and Medicaid standards in one go.
Providers, in turn, only need to submit their data into the portal once, Certify said.
Over time, Rathi said that the team expects the tool to support regulatory compliance as well as member experience by simplifying this onerous back-end task.
“Healthcare providers often face duplicative credentialing requirements that create unnecessary complexities,” said Mike Kane, senior vice president for provider data operations at UnitedHealthcare, in the announcement. “This model will help streamline that process and allow providers to spend more time focused on patient care.”