Provider Network Operations

ProviderTrust’s Provider Network Operations solution delivers the industry’s most accurate provider eligibility insights for payers. It is designed to streamline credentialing, compliance, and operational workflows by providing real-time, verified data on provider eligibility. The platform ensures that only qualified providers are caring for members, reducing risk and improving healthcare outcomes. With NCQA and HITRUST certifications, it supports continuous monitoring and integrates seamlessly into existing systems via API.

Features

• Real-time provider eligibility data verified against primary sources
• Continuous monitoring for exclusions, suspensions, and adverse events
• Monthly exclusion checks across federal and state databases
• DynamicNPI™: Instant access to verified provider data via NPI
• Automated alerts for meaningful changes in provider status
• API-first design for seamless integration into existing workflows
• NCQA-certified credentialing and recredentialing support
• Turnkey automation for license and credential verification

Capabilities

• Connects disparate primary source data directly to NPI numbers
• Feeds accurate data across departments for organization-wide alignment
• Supports full provider lifecycle monitoring—from onboarding to directory management
• Improves operational efficiency by eliminating manual verification tasks
• Delivers exact-match results with minimal noise or false positives
• Scales across provider networks, employees, vendors, and FDRs

Benefits

• Ensures only eligible providers are in-network, protecting patient safety
• Reduces compliance risk and audit exposure
• Accelerates credentialing turnaround times by up to 97%
• Improves data integrity and transparency across the organization
• Enhances member experience through accurate provider data
• Saves time and resources by automating complex workflows