Best Provider Data Management (PDM) Software for Startups

Finally, a single solution to affirm and continuously assess medical provider competency. Ensure excellence in care by offering the industry-leading software for enrolling, onboarding and privileging to continuously evaluate your providers. CredentialStream® incorporates patented technology that provides everything necessary for requesting, gathering, and validating information about a provider, all to establish a reliable Source of Truth for downstream processes. With a modern platform that is continuously updated, along with best-practice content libraries and industry-leading data sets, CredentialStream stands out as the most comprehensive provider lifecycle management solution available. Say goodbye to the headaches, hassles and manual processes that slow you down. Say hello to a modern, continuously updated platform, best-practice content, and industry-leading data that all works together to get your providers where they need to be— seeing patients.

Collaborating for patient care requires constant connectivity and up-to-date information. Simplifying how you exchange that information with your payers is more important than ever. Availity makes it easy to work with payers, from the first check of a patient’s eligibility through final resolution of your reimbursement. You want fast, easy access to health plan information. With Availity Essentials, a free, health-plan-sponsored solution, providers can enjoy real-time information exchange with many of the payers they work with every day. Availity also offers providers a premium, all-payer solution called Availity Essentials Pro. Essentials Pro can help enhance revenue cycle performance, reduce claim denials, and capture patient payments. Availity remains your trusted source of payer information, so you can focus on patient care. Our electronic data interchange (EDI) clearinghouse and API products allow providers to integrate HIPAA transactions and other features into their PMS.

HealthEC’s best population health management platform, comprising our care management module CareConnect™ and our analytics module 3D Analytics™ - is designed to elevate quality of care and patient experience by overcoming the healthcare industry's toughest data challenges. Conquer system chaos with a universal data warehouse of normalized claims, clinical, and SDoH data, from any source. CMS certified for reuse. Eliminate workflow disruption with integrated, customizable care plans, decision-support tools and robust care management support. Deliver patient-centric care by seamlessly coordinating with community resources and addressing social determinants of health. Inform strategies with actionable insights at the diagnosis, provider, practice, and organizational levels, presented in clear dashboards or at the point of care. Enhanced MCO performance reviews and CMS interoperability rule compliance.

At H1, our mission is nothing short of creating a healthier future worldwide by unlocking and democratizing global access to critical expertise, HCP information, claims data, ground-breaking research and discoveries, and connected insights for all – doctors, researchers, industry and, ultimately, patients – bringing everyone closer together to advance medicine and clinical outcomes. Insights derived from H1’s solutions help life sciences and other healthcare organizations accelerate the development, launch, and dissemination of life-saving treatments, drive meaningful engagements with key opinion leaders, and help ensure equitable access to healthcare services.

Medallion is the first solution for healthcare companies to fully offload their clinician operations—state license management, payor enrollment, credentialing, and more—in one modern management platform. By empowering digital health companies, hospitals, payers, and other organizations to credential, license, and monitor their providers with ease from one modern platform, they eliminate time-consuming and laborious tasks that ultimately increases accessibility of care to millions of patients nationwide. Since inception in 2020, Medallion has saved over 100,000 administrative hours for leading healthcare companies like Cerebral, Ginger, MedExpress, Oak Street Health, and hundreds more, and has raised $50M from leading investors like Sequoia Capital, Spark Capital, Optum Ventures, Elad Gil, and Peter Reinhardt.

Certify delivers API-first credentialing, licensing, and enrollment to payors, health systems, and rapidly-scaling digital health companies. We unlock insights and power performance for clinicians, teams, and organizations. Build best-in-class provider networks with our one-click credentialing solution. Real-time, automated NCQA-compliant credentialing to scale provider networks. Automated ongoing monitoring to ensure your provider networks remain compliant. We take the guesswork (and paperwork) out of licensing–so you can scale to new markets, seamlessly. Get in the network and get reimbursed faster, so you can get back to care. Streamlined processes for cross-state licensure in all 50 states for any license category. Streamlined payor enrollment process to get providers in-network in new markets. Track enrollment progress with our individualized dashboards. Leverage our best-in-class methodology to clean, normalize, and enhance your provider data.

symplr Provider credentialing software helps create a single source of provider data, shrinks turnaround times, and shortens revenue cycles, all while prioritizing patient safety. symplr Provider credentialing software makes data gathering, secure access, reporting, and ongoing compliance less burdensome for providers, credentialing staff, and internal approval committees. Our customers report a 20% reduction in credentialing timelines, including a 50% reduction in committee review meetings. Collect, verify, store, and share provider lifecycle data and documents in one automated, user-friendly hub, resulting in time savings and cost containment. With a built-in payer enrollment module, you can enroll providers with payers and easily track applications step-by-step, to get reimbursed faster. Leverage automation to gather data from hundreds of primary sources and auto-check for expired/suspended licenses, NPDB, DEA, SAM, and more.

Save on costs, eliminate data silos, and deliver better outcomes for your members with a unified, automated provider data solution. symplr Payer provides a single source of truth for provider data that is consistently reconciled and validated against primary sources. It improves data quality, access, and transparency. Further, it eliminates duplicate requests for information, reducing provider frustration. Using symplr Payer as the enterprise-wide hub for provider data, payers can feed timely, accurate information to other downstream systems. Our highly configurable, end-to-end provider data management solution manages all pre-contract and renewal contract negotiations. Standardize and streamline your contracting processes, while capturing contract details such as sentinel events, trigger dates, configuration efforts, process steps, fee schedule info, and more. symplr Payer’s unique design allows your organization to consolidate contracting and credentialing.

For three decades, Verisys has served some of the largest and most complex healthcare organizations in the United States, credentialing more than two million events annually. Our provider credentialing services get and keep you compliant. Credentialing and re-credentialing providers is a complex process for health plans, hospitals, and health systems. Physicians are licensed in multiple states and provide telehealth services across state lines. This requires license verification with each state board and compliance with that state’s unique regulations. Identity matching is complicated due to physicians having the same name, maiden names, alias names, nicknames, or abbreviated names. To get a complete view, each physician must be screened, and credentials verified against thousands of primary sources. We can help you do anything from a simple provider credential search to implementing a full end-to-end credentialing solution.

Accelerate payment while decreasing administrative burdens. With 8,000+ payer connections and longstanding partnerships with 650+ practice management vendors, our claims management solutions can result in fewer pending claims and less manual intervention. Quickly and accurately transmit professional, institutional, dental, workers compensation claims and more for fast reimbursement. Meet the shift to healthcare consumerism head on by providing a straightforward and seamless financial experience. Our patient engagement solutions empower you to have informed conversations about eligibility and financial responsibility while reducing hurdles that may impact patient outcomes.

CORE brings the industry together to accelerate automation and develop business processes that streamline healthcare for patients, providers and health plans. Drawing on the industry's most trusted source of provider and member data, CAQH enables healthcare organizations to reduce costs, improve payment integrity and transform business processes. In the ever-evolving landscape of healthcare, continuous improvements in payment and claims processing systems are vital. The nation’s providers and health plans trust CAQH to collect and manage professional information, verify primary sources, and monitor for sanctions. The result, is streamlined administration, greater regulatory compliance, and better provider data management.

Get hours back in your day and millions back in your pocket with our automated solutions. Access the key players—providers, payers, and partners—and the real-time, accurate data you need to never miss a beat in care delivery. We handle all the complex connections across thousands of payers. All you need to know is fast and easy enrollments to any payer starts here. The cloud has never looked this good. Central command to manage, store, and share provider data in real-time—connected everywhere it needs to be. Provider verification made simple. You request it, our platform processes it fast.

SKYGEN’s Provider Data Management (PDM) is an on-demand solution that helps healthcare payers strengthen provider network management and provider relationships. PDM also strengthens payers’ ability to effectively build provider networks, improves provider and member satisfaction, and lowers administrative costs. It’s a smart solution that helps payers and providers meet the needs of today’s technology-savvy healthcare constituents. Lower contract acquisition costs via fast, efficient, paperless provider recruitment and supplemental network rental. Lower credentialing costs and improved provider satisfaction through online credentialing. Eliminating expensive outreach by automating provider self-verification and ensuring accurate and verified provider data for online directories. SKYGEN powers dental and vision connectivity solutions that inspire clients to move confidently into the future by employing technology that creates unparalleled efficiencies.

Innovit’s range of iICE Training programs has been designed to deliver relevant knowledge and skills to your employees. Incorporating ‘best practice’ for the management of product information, you can be confident that your team will continue to develop improved systems and processes for the sustainable management of master data. Innovit is a global solution provider specializing in MDM (Master Data Management), PIM (Product Information Management), GDSN (Global Data Synchronization), UDI Compliance (Unique Device Identification) and NPI Workflow Automation software.

Model N delivers an end-to-end platform empowering companies to maximize revenue as they transform Sales, Marketing, Channels, Finance, and Legal processes. Model N’s revenue management solutions help you maximize revenue by transforming siloed, tactical activities into strategic end-to-end revenue processes through automation and intelligence. Revenue Cloud bridges the gap between front-office and back-office activities providing a unified system of record for all revenue execution. Model N allows customers to easily configure and quote complex products, quickly come to terms on complicated contracts, have more accurate and timely channel data ensuring visibility into channels, and efficiently manage incentive programs avoiding overpayments. Model N Rebate Management helps you better engage your channels to improve and optimize revenue.

Industry-leading provider search, scheduling, and data management solutions that help health systems match patients with the right providers and optimize patient access enterprise-wide. Our provider search and scheduling solutions—built on the Kyruus Connect provider data management platform—enable health systems to optimize patient-provider matching; boost patient acquisition and conversion; and deliver a consistent patient experience across key points of access. Differentiate your digital presence with a modern patient access experience that enables people to find the right care options for their needs and book easily online. Connect consumers with the right providers through your call center by empowering agents with the technology they need to match and schedule patients more precisely. Boost patient retention by giving providers and staff new visibility into the providers in your network and enabling patients to leave their appointment with the next one booked.

In the health care industry, the burden of CMS and state rules and regulations creates time and expense challenges. Outdated processes and the anxiety of not meeting regulatory compliance plague health plan member communications and compliance directors on a daily basis. It’s time to centralize and have visibility over your organization’s compliance program and the entire material creation process. CodySoft® is a revolutionary suite of web-based software products designed specifically for health plans and their complex environment. More controlled and cost-effective project management of member and provider marketing materials. Reduced regulatory compliance risk and increased accuracy. Easy management of investigation issues. Access your dashboard via a secure online portal with no IT integration needed. Easily generate reports for regulatory audits and metrics tracking. See updates occurring in real-time.

Build the interoperability solutions you need. Adapt to any modern environment with Rhapsody, a flexible toolbox that enables your team to build connections quickly and securely. Support the highest level of service with Rhapsody by ensuring that healthcare data is flowing where, when, and how your unique environment demands. Design flexible solutions to every connection need. Streamline workflows with a solution that is infinitely configurable and purpose-built for healthcare. Create intricate integrations with a robust toolkit that has been proven across the world. The platform is represented globally with customers in 36 countries. Develop cutting-edge FHIR-based interfaces simply and easily with REST and FHIR-specific JSON support. Security is of primary concern and is built into every part of the product, with a view to safeguarding any protected health information (PHI) that passes through the engine.

Our platform builds consistency, continuity, and scalability across our integrated portfolio, enabling our customers to improve operational efficiency, decision-making, and patient outcomes—and enabling innovation as our healthcare system evolves. With innovative data and analytics, plus patient engagement and collaboration tools, the Change Healthcare platform helps providers and payers optimize workflows, access the right information at the right time, and support the safest and most clinically appropriate care. We enable access to data and facilitate the interoperability of data between sources to support CMS patient access and interoperability rules, as well as enable real-time access to clinical documents to help better manage risk adjustment, improve HEDIS scores, and support accurate payments with faster adjudication.

symplr Directory is a centralized provider data management solution designed to streamline healthcare operations and improve patient experiences. By consolidating and maintaining accurate provider data in a single platform, symplr Directory helps healthcare systems reduce errors, enhance network retention, and improve the accuracy of patient-provider matching. The platform enables seamless integration with electronic health records (EHRs), allowing providers to spend less time on administrative tasks and more time delivering care. It also helps healthcare organizations reduce patient leakage, improve revenue cycles, and increase patient acquisition through a user-friendly, digital front door.