Provider Network Monitoring

Be confident in your providers with set-it and forget-it compliance that ensures your provider network will not pose an additional risk due to malpractice, legal penalties, or disciplinary actions.

Automated Provider Network Monitoring for NCQA Compliance and Beyond

• Avoid Risky Providers
• Direct Connections to Top Sources
• Alerts Enable Fast Action

Easily Enroll Providers in Ongoing Monitoring

Add newly credentialed providers to your preferred monitoring program with one-click.

Tackle Compliance Audits with Confidence

All monitoring sources are tracked with historical activity logs, so no detail is missed.

We've Got You Covered with 3,200+ Available Sources

State Licenses

Never get caught off guard by a license expiration again–Verifiable directly connects to 200+ state and national license sources for provider types including:

• Counseling/Therapists
• Dentistry
• Medicine
• Nursing
• Optometry
• Pharmacy
• Psychology
• Social work
• Speech pathology
• and more….

SAM

System of Award Management Dodge potential fraud by checking your provider network against SAM’s list which includes individuals and entities who have been debarred, sanctioned, or excluded by a federal agency.

DEA

Drug Enforcement Administration Prevent drug misuse and fraudulent prescriptions by ensuring the providers in your network are properly registered and not under investigation with the DEA.

NPDB

National Provider Data Bank Access continuous query to get notified of new flags on your providers within 24 hours of the adverse action being reported. NPDB maintains information on the following:

• Medical malpractice payments
• Federal and state licensure and certification actions
• Adverse clinical privileges actions
• Adverse professional society membership actions
• Negative actions or findings by private accreditation organizations and peer review organizations
• Health care-related criminal convictions and civil judgments
• Exclusions from participation in a Federal or state health care program (including Medicare and Medicaid exclusions)
• Other adjudicated actions or decisions

OIG

Office of the Inspector General Avoid costly civil monetary penalties by ensuring your providers are not listed on OIG’s List of Excluded Individuals/Entities – making them excluded from reimbursement via medicare, medicaid, or other federal programs.

State Sanctions and Exclusions

Comply with federal regulations by ensuring your provider network does not include individuals who have been disciplined or lost license privileges from their state’s specific enforcement agency–as this is cause for termination according to Section 6501 of the Affordable Care Act.

Medicare Opt-Out

Avoid potential billing issues and penalties by knowing which providers in your network have chosen not to receive reimbursement from medicare.

NPI

National Provider Identification A standard set forth by HIPAA for the administrative simplification of financial transactions, a provider’s NPI should be regularly verified to avoid unexpected billing delays.

OFAC

Office of Foreign Assets Control Ensure the physicians you hire and the partners you work with are considered safe and trustworthy.

SSA-DMF

Social Security Administration Death Master File Steer clear of fraudulent providers by conducting regular checks of your network against the social security administration's official list of deceased persons.

How Does Ongoing Monitoring Work?

Verifiable’s unique monitoring solution is designed to give you the most up-to-date information on the health and compliance of your provider network. By conducting an “active” monitoring approach, we empower you with near real-time data on providers who may put you at risk.

Ongoing Monitoring

• “Listens” for changes from sources on a continuous basis
• Alerts you in real-time of any flagged providers
• Same-day alerts for any at-risk providers

Frequency Monitoring

• “Scans” for changes from sources on a set schedule (typically monthly)
• Alerts you based on set schedule of any flagged providers
• Potential 30-day delay for alerts on at-risk providers