Provider Network Compliance

ProviderTrust’s Provider Network Compliance solution delivers automated, continuous monitoring of provider eligibility across healthcare networks. It ensures only qualified providers are caring for members by verifying data against primary sources and alerting organizations to changes in real time. The platform supports compliance teams with audit-ready documentation and exact-match results, reducing risk and improving operational efficiency.

Features

• Automated exclusion list monitoring across federal and state databases
• Real-time alerts for changes in provider eligibility status
• Primary source license and credential verification
• Exact-match data results with enhanced accuracy
• HITRUST and NCQA-certified compliance infrastructure
• Monitoring for participating and non-participating providers
• Coverage for vendors, employees, and FDRs
• Fully automated workflows for continuous compliance

Capabilities

• Consolidates monitoring across diverse provider networks
• Connects disparate data sources to NPI numbers for unified oversight
• Feeds verified data into existing systems via API or SFTP
• Supports credentialing, recredentialing, and audit preparation
• Scales across healthcare organizations of all sizes
• Delivers actionable insights for compliance and operations teams

Benefits

• Reduces compliance risk and exposure to fraud, waste, and abuse
• Improves data integrity and operational transparency
• Eliminates manual verification tasks and reduces administrative burden
• Ensures audit readiness with complete documentation
• Protects patient safety by ensuring only eligible providers are active
• Accelerates credentialing processes and improves efficiency