Provider Credentialing

Automate provider credentialing verification, license checks, sanctions screening, and ongoing monitoring

Provider credentialing is one of the most labor-intensive processes in healthcare operations. Credentialing teams must verify education, training, licensure, board certifications, malpractice history, and sanctions status for every provider—a process that typically takes 90-120 days per provider using manual workflows. With networks of over a million providers requiring re-credentialing every 2-3 years, teams face a perpetual backlog. Delays in credentialing directly impact network adequacy and prevent providers from seeing patients, while missed sanctions checks create serious compliance and patient safety risks. This agentic workflow automates the verification pipeline from initial application through ongoing monitoring. A Document Collector gathers and validates required credentials from providers and primary sources. A Verification Agent cross-references licenses, certifications, and education against authoritative databases (NPPES, state medical boards, ABMS, DEA). A Sanctions Screener continuously monitors OIG, SAM, and state exclusion lists. When all verifications pass, the system auto-advances the application; discrepancies or flags route to human credentialing specialists for review. Organizations implementing automated credentialing report 60-70% reduction in credentialing cycle time (from 90+ days to 30-40 days) and near-elimination of sanctions screening gaps. Automation of primary source verification reduces manual effort by 80%, allowing credentialing staff to focus on complex cases. This is critical for any health plan, hospital system, or credentialing verification organization (CVO) where credentialing speed directly impacts provider onboarding and network growth.