Best Provider Data Management (PDM) Software

Finally, a single solution to affirm and continuously assess medical provider competency. Ensure excellence in care by offering the industry-leading software for enrolling, onboarding and privileging to continuously evaluate your providers. CredentialStream® incorporates patented technology that provides everything necessary for requesting, gathering, and validating information about a provider, all to establish a reliable Source of Truth for downstream processes. With a modern platform that is continuously updated, along with best-practice content libraries and industry-leading data sets, CredentialStream stands out as the most comprehensive provider lifecycle management solution available. Say goodbye to the headaches, hassles and manual processes that slow you down. Say hello to a modern, continuously updated platform, best-practice content, and industry-leading data that all works together to get your providers where they need to be— seeing patients.

Medallion is the first solution for healthcare companies to fully offload their clinician operations—state license management, payor enrollment, credentialing, and more—in one modern management platform. By empowering digital health companies, hospitals, payers, and other organizations to credential, license, and monitor their providers with ease from one modern platform, they eliminate time-consuming and laborious tasks that ultimately increases accessibility of care to millions of patients nationwide. Since inception in 2020, Medallion has saved over 100,000 administrative hours for leading healthcare companies like Cerebral, Ginger, MedExpress, Oak Street Health, and hundreds more, and has raised $50M from leading investors like Sequoia Capital, Spark Capital, Optum Ventures, Elad Gil, and Peter Reinhardt.

CertifyOS delivers API-first credentialing, licensing, and enrollment to payors, health systems, and rapidly-scaling digital health companies. We unlock insights and power performance for clinicians, teams, and organizations. Build best-in-class provider networks with our one-click credentialing solution. Real-time, automated NCQA-compliant credentialing to scale provider networks. Automated ongoing monitoring to ensure your provider networks remain compliant. We take the guesswork (and paperwork) out of licensing–so you can scale to new markets, seamlessly. Get in the network and get reimbursed faster, so you can get back to care. Streamlined processes for cross-state licensure in all 50 states for any license category. Streamlined payor enrollment process to get providers in-network in new markets. Track enrollment progress with our individualized dashboards. Leverage our best-in-class methodology to clean, normalize, and enhance your provider data.

Save on costs, eliminate data silos, and deliver better outcomes for your members with a unified, automated provider data solution. symplr Payer provides a single source of truth for provider data that is consistently reconciled and validated against primary sources. It improves data quality, access, and transparency. Further, it eliminates duplicate requests for information, reducing provider frustration. Using symplr Payer as the enterprise-wide hub for provider data, payers can feed timely, accurate information to other downstream systems. Our highly configurable, end-to-end provider data management solution manages all pre-contract and renewal contract negotiations. Standardize and streamline your contracting processes, while capturing contract details such as sentinel events, trigger dates, configuration efforts, process steps, fee schedule info, and more. symplr Payer’s unique design allows your organization to consolidate contracting and credentialing.

For three decades, Verisys has served some of the largest and most complex healthcare organizations in the United States, credentialing more than two million events annually. Our provider credentialing services get and keep you compliant. Credentialing and re-credentialing providers is a complex process for health plans, hospitals, and health systems. Physicians are licensed in multiple states and provide telehealth services across state lines. This requires license verification with each state board and compliance with that state’s unique regulations. Identity matching is complicated due to physicians having the same name, maiden names, alias names, nicknames, or abbreviated names. To get a complete view, each physician must be screened, and credentials verified against thousands of primary sources. We can help you do anything from a simple provider credential search to implementing a full end-to-end credentialing solution.

Accelerate payment while decreasing administrative burdens. With 8,000+ payer connections and longstanding partnerships with 650+ practice management vendors, our claims management solutions can result in fewer pending claims and less manual intervention. Quickly and accurately transmit professional, institutional, dental, workers compensation claims and more for fast reimbursement. Meet the shift to healthcare consumerism head on by providing a straightforward and seamless financial experience. Our patient engagement solutions empower you to have informed conversations about eligibility and financial responsibility while reducing hurdles that may impact patient outcomes.

CORE brings the industry together to accelerate automation and develop business processes that streamline healthcare for patients, providers and health plans. Drawing on the industry's most trusted source of provider and member data, CAQH enables healthcare organizations to reduce costs, improve payment integrity and transform business processes. In the ever-evolving landscape of healthcare, continuous improvements in payment and claims processing systems are vital. The nation’s providers and health plans trust CAQH to collect and manage professional information, verify primary sources, and monitor for sanctions. The result, is streamlined administration, greater regulatory compliance, and better provider data management.