PROVIDER DATA MANAGEMENT
The source of truth for provider data.
CertifyOS is the provider data infrastructure that makes everything downstream work better — credentialing, directories, claims, prior authorization, fraud waste and abuse, network adequacy, and care routing. We aggregate provider data from thousands of sources into one governed Master Data Management (MDM) layer with a golden record per provider.
- Aggregate thousands of data sources — Primary Sources, CAQH, NPPES, CMS data, Availity, delegated/direct rosters, and internal contracting systems
- One golden record per provider with full lineage, history, and survivorship at the field level
- API-first delivery of clean provider data to claims, directories, prior auth, fraud waste and abuse, provider relations, and care routing
Book a 20-minute demo
See the provider data infrastructure that powers credentialing, directories, claims, prior auth, and everything downstream.
Trusted by leading health plans, digital health companies, and provider networks
The provider data backbone for health plans
- 40-60%reduction in directory errors
- 90%reduction in manual roster reconciliation effort
- 50%reduction in NSA non-compliance risk
- 8of the 10 publicly listed US Health Plans are CertifyOS Clients.
THE PROBLEM
Provider data lives in 5+ systems at most health plans.
Primary Sources, CAQH, NPPES, CMS data, Availity, delegated rosters, direct rosters, contracting systems, internal claims data — every health plan has provider data in dozens of places, with conflicting values, no lineage, and no source of truth.
Most plans bolt point solutions onto that fragmented base: a credentialing tool, a directory platform, an attestation workflow, a roster ingestion script. None of them solve the underlying problem — the provider data they all depend on is wrong, stale, or contradictory across sources. CertifyOS replaces the fragmented base with one master data layer.
One golden record. Five MDM capabilities.
Complete entity management
Model every provider, practice, facility, and organizational relationship — solo practitioners, delegated groups, and multi-entity affiliations.
Golden record with full lineage
Aggregate data from thousands of sources into one Unified Provider Record. See every source, every survivorship decision, every historical change — fully auditable down to the field level.
Configurable survivorship logic
You choose which source wins for each data element. Trust CAQH for specialty, roster for credentials, provider portal for panel status. Configure at the field level.
Real-time API access
API-first delivery of provider data to every downstream system — directories, claims, prior auth, fraud waste and abuse, provider relations, and care routing.
Compliance and AI-readiness
Continuous compliance for No Surprises Act and CMS standards with audit logging and directory-ready outputs. Clean, governed provider data is the foundation for AI-driven workflows.
CertifyOS PDM vs. the legacy stack.
CertifyOS PDM
- One golden record per provider, across all sources
- Field-level lineage and survivorship
- Built on real provider relationships and ontology
- Real-time API access
- MDM-grade data governance built in
Legacy stack
- Provider data scattered across 5+ systems
- No lineage; no way to trace data origin
- Flat tables that don't model real relationships
- Batch file exports on quarterly cadence
- Compliance bolted on per system
FROM OUR CLIENTS
“Provider data is the backbone of every payer workflow — credentialing, directories, claims, prior auth, network adequacy. CertifyOS is building the source of truth health plans can finally trust as a strategic asset, not a liability.”
— CertifyOS PDM Team