News ProviderTrust Celebrates 16 Years of Keeping Healthcare Safe. Learn More
Data Built for Payers
Payers are responsible for the accuracy of the provider networks their members depend on. ProviderTrust helps payer teams maintain visibility into network status, reduce administrative friction, and stay ahead of network compliance and directory accuracy requirements, all from one connected dataset instead of a different view for every department.
WHY IT MATTERS
A provider directory is a promise to your members: this person is in-network, licensed, and available to see patients. In a joint analysis with Defacto Health covering 124 payer directories, almost 9 in 10 networks (89%) carried at least one currently excluded provider, and every single network had at least one license, registration, or certification issue. Roughly 1 in 5 providers industry-wide had a license status issue, not misconduct, just a gap a periodic check didn’t catch in time.
State exclusion lists account for 77% of exclusions found in that analysis, while federal lists, the ones most monitoring programs check first, account for only 23%. And close to 1 in 4 excluded providers surfaced only through enhanced primary source verification and data enrichment, meaning a standard point-in-time check would have missed them entirely.
Types of payers
ProviderTrust serves the following types of payers:
USE CASES
ProviderTrust moves primary source verification off the critical path, delivering DynamicNPI results in about half a second per provider. Monitoring continues after the initial check, so status changes between credentialing cycles don’t lead to paying an ineligible provider.
Elements monitored include license, credential, board certification, DEA/CDS registration status, and NPI validation.
Compliance teams use ProviderTrust to monitor their entire network, not just providers on the roster, screening participating and non-participating providers, employees, vendors, and FDRs against the same standard.
Elements monitored include OIG LEIE, GSA-SAM.gov, state Medicaid exclusions, the CMS Preclusion List, NPPES NPI status, Medicare Opt Out, OFAC SDN/non-SDN lists, state licensing and board actions, and DEA/CDS registration.
Keeping directory data connected across credentialing, compliance, and directory management — rather than siloed — is where ProviderTrust helps network operations teams most. Continuous monitoring surfaces adverse events, like exclusions, suspensions, or license changes, keeping directory and network status aligned without manual reconciliation.
Elements monitored include license and credential verification, exclusion and sanctions monitoring, and adverse event alerts associated with each provider’s record.
Our mission is to create safer healthcare for everyone.
WHY PROVIDERTRUST
Every organization approaches credentialing differently. ProviderTrust’s healthcare credentialing solutions deliver data where you need it, integrated directly into your workflows or accessible through a centralized platform.
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