UnitedHealthcare, Cigna, Centene Join CertifyOS Provider Credentialing Program

The new model is designed to address a process in which healthcare providers often complete separate credentialing applications for multiple payers.

CertifyOS has launched a National Shared Credentialing Program with UnitedHealthcare, Cigna and Centene as initial participants, aiming to standardize provider credentialing and eliminate duplicate submissions across health plans.

The new model is designed to address a process in which healthcare providers often complete separate credentialing applications for multiple payers. CertifyOS said providers submit an average of 17 credentialing applications annually, creating additional administrative work and costs.

Under the program, participating health plans provide CertifyOS with information on providers requiring credentialing. CertifyOS then manages the credentialing process, including provider outreach, submission verification and checks against National Committee for Quality Assurance (NCQA) and Medicaid standards.

Providers will be able to submit their credentialing information through the CertifyOS platform once, rather than separately providing the same information to each participating health plan.

Anshul Rathi, CEO of CertifyOS, said the company expects between 1.4 million and 2 million providers to complete credentialing through its platform next year. The program is planned for launch this fall.

CertifyOS estimates that the US healthcare system spends more than $2 billion annually on provider credentialing. The company said a unified process could potentially reduce credentialing-related costs by up to 75%.

Health plans currently spend an estimated $200 to $500 per provider per credentialing cycle, while providers incur approximately $700 annually in costs and time associated with submitting applications to different payers, according to CertifyOS.

Mike Kane, senior vice president for provider data operations at UnitedHealthcare, said the shared model is intended to reduce duplicative credentialing requirements and allow providers to spend more time on patient care.

CertifyOS said the platform could also support regulatory compliance and improve provider data management as participation expands.

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