CELDIFYOS unveils provider data platform to simplify operations and cut costs
The company announced last week that provider data intelligence company Certifyos has launched a new platform to help payers manage provider data across their networks.
New York City-based Certifyos serves health programs and digital health companies and is working to simplify access to provider data, whether it is a provider directory or medical claims. Its new AI-driven platform, called “Provider Center”, takes data from a range of sources (vouchers, directories, claims, lists, etc.) and cleanses it and unifies it into a single file for the payer.
The platform integrates directly with downstream systems such as contracts, catalogs and claims systems. It identifies when the gap between data and flag issues can help support decision-making. Additionally, it constantly monitors provider data and sends alerts on outdated records.
Anshul Rathi, founder and CEO of CELDIFYOS, said the new provider center is important because every part of the healthcare operation, including payment integrity claims, membership experience and provider catalogs, is affected by inaccurate provider data. The healthcare industry spends about $3 billion a year to manually update the provider catalog.
“What we have today are dozens of provider data teams picking up the phone, calling the provider and maintaining their own system of records. So even within the organization, if the team has the latest provider data, it won't be transferred to other parts of the organization,” he said.
“We believe this is one of the biggest reasons for the irreversible administrative costs of the U.S. healthcare industry,” he continued. “There should be a central hub related to all of this disconnected source and provider itself, that any changes in the source, source or provider in the data source will be reflected in the data source, making it a de facto source of truth. That's the hub for certified providers.”
Rathi added that Certifyos already has about 30 payer clients, including the National Plan and the Medicare Advantage Plan. However, he refused to name a specific client. Payers pay for the platform, and most importantly, subscriptions.
The provider hub was launched shortly after raising $40 million in Series B funding in June. This funding helps support the creation of this new platform.
Ultimately, Certifyos aims to “fundamentally change the way health care in the U.S. interacts with provider data.”
“The goal is that patients have a lot of experience,” he notes. “If they go to the doctor, their insurance is accepted, and the doctors are actually working there, and they don’t have to chase the insurance company with claims. … This is a big part of the overall experience of what we do. At the same time, we believe that we don’t think providers should take the time to fill the same application or sign multiple times with multiple payers.”
Photo: Yuichiro Chino, Getty Images
