Provider Credentialing and Enrollment

Automated Validation and Updates
prior authorization automation
$6B
annual expense for provider data corrections

Overview

Provider Credentialing Automation

Credentialing is the process of confirming the qualifications of a licensed or certified health care practitioner​. But it is also marred by time-consuming components, like intake, verification, matching, and publishing. By automating this process organizations can reduce cycle-time and resources related to provider credentialing efforts.

Process Automation

Intelligent, Automated Provider Enrollment

Intake, Extract, and Validate

The goal of our intelligent, automated platform is to streamline provider enrollment form filling and credentialing across multiple payer portals, eliminating manual processing inefficiencies and reducing errors through AI-powered automation. By using agents for data mapping, review, and enrollment, the entire process should result in greater than 95% accuracy without the need for any manual intervention.

Like all automation and AI processes, human-in-the-loop steps are included to ensure the highest levels of accuracy and strictest adherence to compliance.

provider credentialing and enrollment

Provider Credentialing and Enrollment Experts

Talk to our dedicated team of healthcare payer automation experts today and learn how our credentialing and enrollment automations can help your organization.

Contact Us

Frequently Asked Questions

Provider credentialing is the process healthcare payers use to verify a provider’s qualifications—such as education, licenses, training, and work history—before allowing them to join a network and receive reimbursement. It ensures that only qualified, compliant professionals deliver care to insured members. Credentialing is typically followed by provider enrollment, which links the approved provider to the payer’s system for billing and payment.

Credentialing remains inefficient because it’s a manual, paper-heavy, and fragmented process involving multiple payers, systems, and verification sources. Each payer typically requires its own forms, documentation, and timelines, leading to duplication and delays. Data inconsistencies, slow primary source verifications, and limited interoperability between credentialing systems can stretch timelines from weeks to months—delaying provider onboarding, patient access, and reimbursement.

Automation and centralized data management can streamline document collection, reduce errors, and speed up verifications, allowing providers to onboard faster and begin seeing patients sooner.

Credentialing is the initial approval process for joining a payer’s network, while recredentialing (usually every 2–3 years) ensures provider information and qualifications remain current and compliant.

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