CertifyOS

by CertifyOS  · Based in United States → — Provider Data Truth for Healthcare
Family Medicine Internal Medicine Pediatrics
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Enterprise
Documentation ProvidedRegulatory Status Disclosed

Overview

CertifyOS is a provider intelligence platform designed to address the fragmented and often inaccurate nature of provider data within the healthcare industry. It offers an AI-enabled, API-first infrastructure that serves as a single source of truth for all provider-related information. The platform automates critical administrative processes such as credentialing, licensing, payer enrollment, and ongoing network monitoring, significantly reducing manual effort and administrative burdens.

For physicians and healthcare organizations, CertifyOS streamlines the complex and time-consuming workflows associated with joining and maintaining networks. By integrating with thousands of primary sources and leveraging AI-driven logic, it ensures real-time verification and continuous updates of provider data, improving accuracy and compliance with regulatory standards like NCQA.

The platform’s modular design allows for custom configurations, enabling health plans, digital health companies, and health systems to integrate the necessary products for their specific needs, including Roster Management (RosterOS) and Provider Hub. This leads to proven results such as reduced re-credentialing costs, fewer roster mismatches, and faster provider onboarding, ultimately enhancing operational efficiency and enabling better data-driven decisions across the healthcare ecosystem.

Reviewed by Pouyan Golshani, MD — Interventional Radiologist

Key Features

  • Automated Credentialing & Re-credentialing
  • Automated Licensing & Payer Enrollment
  • Real-time Network Monitoring & Alerts
  • AI-enabled Single Source of Truth for Provider Data
  • API-first Architecture for Seamless Integration
  • Roster Management (RosterOS) with Data Ingestion & Validation
  • Provider Hub for End-to-End Provider Data Management
  • NCQA-compliant Primary Source Verification (PSV)
  • Custom Directory Export Capabilities
  • Audit Trails and Compliance Management

Use Cases

  • Streamlining Provider Credentialing and Re-credentialing
  • Automating Provider Licensing and Payer Enrollment
  • Ensuring Real-time Provider Network Accuracy and Compliance
  • Reducing Administrative Burden and Operational Costs
  • Faster Provider Onboarding and Network Expansion
  • Improving Data Quality for Claims, Directories, and Analytics

What Physicians Need to Know

Key Capabilities
CertifyOS offers an AI-powered Provider Data Platform that unifies provider data from various sources (rosters, primary sources, EMRs, claims) into a single, continuously updated source of truth. It provides automated, API-first credentialing, licensing, enrollment, and network monitoring, including real-time verification against thousands of sources (e.g., state licenses, board certifications, NPI, DEA, OIG, SAM, OFAC, Medicare opt-out, state Medicaid sanctions). The platform also features AI-driven data cleansing to resolve duplicates and standardize information, along with continuous monitoring for compliance and changes in provider credentials.
Clinical Utility
The platform significantly reduces administrative burdens and costs associated with provider data management, leading to faster provider onboarding (up to 80% reduction in credentialing times and 50% faster onboarding) and re-credentialing (75% cost reduction). It achieves over 90% data accuracy and reduces roster mismatches by 50%, ensuring reliable provider information for claims, directories, and patient referrals. This efficiency allows healthcare professionals to focus more on patient care by streamlining compliance and improving access to qualified providers.
Integration Options
CertifyOS is built with an API-first architecture, enabling seamless, real-time data exchange with various healthcare systems, including Electronic Health Records (EHRs), Revenue Cycle Management (RCM) systems, contracting, directories, and claims systems. It supports real-time APIs, webhooks, and secure file exchange for ingesting and delivering data. The platform is also available as an application on the Salesforce AppExchange.
Compliance Status
CertifyOS is a National Committee for Quality Assurance (NCQA) Certified Credentials Verification Organization (CVO), accredited for 11 out of 11 verification services, ensuring adherence to high-quality standards. The company achieved SOC 2 Type 1 certification in July 2023 and SOC 2 Type 2 certification in April 2024, demonstrating robust security controls and commitment to data protection. Its controls align closely with HIPAA requirements for protecting Protected Health Information (PHI). The platform also helps meet CMS and No Surprises Act requirements.
Pricing Model
The pricing model is not publicly disclosed and is typically shared during the sales process. It follows a traditional SaaS subscription model, often including platform fees, implementation or onboarding fees, and potentially bundled features. Multi-year contract options are available, and the model is designed to scale with larger organizations. Discounts may be available for non-profits.
User Experience
CertifyOS is described as having a modern, user-friendly interface designed for operators, aiming to eliminate manual processes and streamline workflows. It offers real-time status updates, dashboards, and alerts for expirables and bottlenecks. While generally positive, some users have reported a potential learning curve.
Support Quality
Customer testimonials highlight CertifyOS as a 'highly valuable partner' with 'expertise and efficiency,' leading to 'remarkable improvements in provider support, reliability, and efficiency' through a 'collaborative approach and reliable assistance.' However, one review source noted ticket-based support with occasional delayed or inconsistent response times.
Implementation Complexity
CertifyOS is designed with an API-first architecture, which can lead to faster deployment compared to replacing legacy platforms, as it connects existing workflows. It offers a customizable solution that can be configured to meet unique organizational needs, with quick and simple mapping of provider data fields, especially within Salesforce. The company emphasizes replacing outdated workflows rather than just digitizing them, and works with clients to identify automation opportunities.
Evidence Base
CertifyOS cites proven results, including a 75% reduction in re-credentialing costs, 50% fewer roster mismatches, and 10x faster provider onboarding. Other metrics include an 80% reduction in credentialing times, 19% increased provider NPS satisfaction, and 50% faster provider onboarding. Case studies with partners like Oscar Health and OncoHealth demonstrate significant decreases in cost, more efficient operations, and improved provider satisfaction. A company report also suggests that automation can lead to a 15-20% reduction in administrative costs and a 10-15% increase in data accuracy for health plans.
Physician Tip

For healthcare professionals, CertifyOS streamlines the often-cumbersome processes of credentialing, licensing, and payer enrollment. By automating data verification and continuous monitoring, it significantly reduces the administrative burden, allowing more time for patient care. The platform's ability to maintain accurate and up-to-date provider data also ensures compliance, reduces delays in getting in-network, and minimizes the risk of claim denials due to credentialing issues. This means less paperwork, faster onboarding, and more reliable information for both individual practitioners and larger groups.

CertifyOS is built on an API-first architecture, making it highly adaptable for integration. It can seamlessly connect with existing Electronic Health Record (EHR) and Revenue Cycle Management (RCM) systems, as well as other downstream platforms like contracting, directories, and claims processing. This robust interoperability ensures that provider data is unified and accessible across an organization's entire healthcare IT ecosystem, eliminating data silos and enabling real-time information flow for improved operational efficiency and decision-making.

Details

Category Credentialing & Enrollment, Practice Management & Scheduling
Pricing Enterprise
Free Trial No
DeploymentCloud
Mobile AppNone
API Available Yes
Data Export Yes
Training Yes
Compliance
BAA AvailableUnknown
HIPAA Compliant Yes AI-estimated
FDA Status Not applicable AI-estimated
SOC 2 Yes AI-estimated
Integrations
EHR Not specified
Specialties Family Medicine, Internal Medicine, Pediatrics

Support & Reliability

Training Provided Yes

What the Web Says

CertifyOS is generally well-regarded as a platform that streamlines provider credentialing and enrollment processes, leveraging AI and automation to reduce manual effort and accelerate onboarding. Reviewers frequently highlight its ability to improve operational efficiency and data accuracy for healthcare organizations.

Overall: Positive

Strengths

  • Significantly reduces provider credentialing and enrollment times.
  • Automates data collection and verification, improving accuracy.
  • Centralized platform for managing provider data.
  • User-friendly interface and intuitive design.
  • Enhances operational efficiency for healthcare organizations.
  • Proactive alerts for expiring credentials.

Limitations

  • Integration with existing legacy systems can sometimes be complex.
  • Initial setup and data migration may require significant effort.
  • Some users desire more customization options for specific workflows.
  • Reliance on external data sources can sometimes lead to delays if those sources are slow.
  • Cost might be a consideration for smaller practices.
  • Learning curve for new users to fully utilize all features.

Based on reviews from: G2, Capterra, Healthcare IT News, TechCrunch, Reddit (healthcare IT discussions), Physician forums

Last updated: 2026-07-30

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Press & Coverage

MedCity News
CertifyOS Unveils Provider Data Platform to Streamline Operations and Cut Costs
CertifyOS launched Provider Hub, an AI-powered platform designed to help payers unify provider data and reduce administrative costs by taking data from various sources and cleaning it into a single file. This platform aims to fundamentally change how U.S. healthcare interacts with provider data, improving patient experience and reducing claims issues.
2025-10
PR Newswire
CertifyOS Launches the Only End-to-End Provider Data Management Platform Designed to Eliminate Fragmentation and Reduce Costs
CertifyOS announced the launch of Provider Hub, an end-to-end Provider Data Management (PDM) solution offering a unified, real-time, 360-degree view of every provider in a healthcare organization's network. This platform addresses issues of inaccurate provider data that lead to friction in health plan functions, harm member experience, delay payments, and increase compliance risk.
2025-10
CertifyOS
CertifyOS Secures $40M Series B Funding to Continue Building the Healthcare Provider Data Infrastructure of the Future
CertifyOS raised $40M in Series B funding to continue developing its healthcare provider data infrastructure, aiming to solve the chaos of provider data that drives significant costs and delays in healthcare. The company is building a single source of truth for provider data, continuously updated from primary sources and accessible via a single API.
2025-06
CertifyOS
CertifyOS and Candor Health Partnership Announced
CertifyOS announced a strategic partnership with Candor Health to create a highly accurate, intelligent, and scalable Provider Data Management (PDM) solution. This collaboration combines CertifyOS's MDM and provider data infrastructure with Candor Health's data accuracy engine to transform how health plans manage and verify provider data.
2025-10
CertifyOS
Fast Company Names CertifyOS to Fourth Annual List of the Next Big Things in Tech
CertifyOS was recognized by Fast Company on its fourth annual 'Next Big Things in Tech' list, which honors emerging technologies with a profound impact across various industries. This acknowledgment highlights CertifyOS's innovative contributions to healthcare technology.
2024-11
CertifyOS
CertifyOS Releases Blueprint Report for Provider Credentialing Automation
CertifyOS released an ebook, 'Provider Credentialing - A Complete Guide to the Building Blocks of Network Management,' offering strategic insights to improve credentialing processes through automated data collection and system integration. The report indicates that automation can lead to a 15-20% decrease in administrative costs and a 10-15% increase in data accuracy for health plans.
2024-07
CertifyOS
CertifyOS Launches RosterOS to Streamline Provider Roster Management
CertifyOS announced the launch of RosterOS, a solution designed to streamline provider-entity data management and reduce administrative burden for health plans. RosterOS aims to consolidate multiple provider rosters into a single source of truth, improving data cleanliness and reducing processing times significantly.
2024-07
CertifyOS
CertifyOS Achieves Third Consecutive SOC-2 Compliance
CertifyOS announced it has achieved Service Organisation Control (SOC) 2 Type 2 compliance for the second consecutive year, building on its initial SOC-2 Type 1 certification. This demonstrates CertifyOS's commitment to maintaining high standards of security, privacy, and compliance in the digital healthcare environment.
2025-05

Videos

Product demos, reviews, and walkthroughs for CertifyOS.

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Frequently Asked Questions

CertifyOS automates data collection and primary source verification, aiming to reduce manual paperwork and accelerate credentialing timelines from weeks to days. It integrates with CAQH to standardize application information and auto-roster provider data, minimizing repeated data entry.
CertifyOS is NCQA-certified for 11 out of 11 credentialing verification services, demonstrating adherence to high-quality standards. The platform offers continuous monitoring for sanctions, exclusions, and license expirations, providing real-time alerts to help maintain compliance.
Alternatives to CertifyOS include platforms like Assured, CredentialStream, Modio Health, symplr Provider, and Verifiable. While CertifyOS is an API-first platform focused on automation and serving larger entities, some alternatives may offer more hands-on support, broader practice management tools, or a services-first approach.
CertifyOS generally uses a pricing model that includes platform fees, implementation or onboarding fees, and multi-year contract options, with pricing shared during the sales process rather than publicly. It primarily serves health plans, digital health companies, and larger provider groups, suggesting that individual physicians or small practices might access it through their affiliated organizations rather than direct subscription.
While CertifyOS is an API-first platform designed for interoperability, integrating it with every unique existing EHR or practice management system might require technical effort, though it supports integration with major EHR/RCM systems and CRMs like Salesforce. The platform is often adopted by larger organizations to manage their provider networks, meaning individual physicians might interact with it through their health system or payer, potentially having less direct control over the system's configuration.
CertifyOS provides continuous monitoring of provider sanctions, exclusions, disciplinary history, and license expirations, offering automated alerts for any changes. This proactive monitoring helps ensure ongoing compliance with regulatory requirements and accreditation standards between re-credentialing cycles.

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Suggest an Edit → | Report an issue | Last Verified: 2026-04-30 | First Added: 2026-04-30
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