Ensuring quality, and compliance at every turn

Streamline your compliance operations with a trusted, automated monitoring solution designed for your business.

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COMPLIANCE

Quality Assurance
Continuously monitor provider sanctions, exclusions and disciplinary history for “bad actors” to ensure quality across your network and identify suboptimal providers for improvement measures or removal.
Compliance Management
Automated provider monitoring systems help you proactively monitor provider credentials, licenses, certifications, and other compliance-related information, minimizing the risk of non-compliance and associated penalties.

NCQA-Certified

Partner with an experienced CVO that’s NCQA-certified for 11 out of 11 verification services.

PERFORMANCE

Member Safety
Quickly identify risks or concerns related to provider competence, malpractice history, or disciplinary action so you can take immediate next-steps to protect member safety and prevent harm.
Real-Time Sanctions Monitoring
Monitor your network across multiple data sources in real-time to provide actionable insights at the provider level and guarantee improved member outcomes and satisfaction.

How CertifyOS can help simplify and streamline the monitoring process for healthcare organizations.

Automated Monitoring
Automate the monitoring process through real-time alerts and continuous notifications. Tracking key provider metrics, credentials, licenses, and certifications allows you to stay informed about any provider status changes or updates.
Compliance Tracking
Remain compliant by monitoring and managing provider credentials, licenses, certifications, and adherence to regulatory requirements. CertifyOS makes it easy for you to track expiration dates, renewal statuses, and compliance documentation.
Performance Analytics
Our platform offers comprehensive performance analytics, enabling organizations to track and evaluate provider performance based on various quality measures.
Customizable Reporting
Customize in-platform reporting features and allow your business to generate detailed reports on provider monitoring activities. These reports facilitate data-driven decision-making and support audits and accreditations.

How It Works:

“Through the partnership with CertifyOS, OncoHealth experienced remarkable improvements in provider support, reliability, and efficiency. The collaborative approach and reliable assistance provided by CertifyOS enhanced productivity and streamlined operations for OncoHealth's provider teams.”

Cliff Culver, Chief Operating Officer, OncoHealth

FREQUENTLY ASKED QUESTIONS:

What does ongoing monitoring include?
We leverage integrations with a wide variety of external sites, such as DEA/CDS lists, board certification sites like ABMS and AOA, OIG, GSA, Medicare Opt-Out, NPDB via continuous query, and FSMB, to perform monitoring. Monitoring includes:
-Expirables monitoring (State License, DEA, Board Certifications)
-Sanctions Monitoring including Federal (GSA, SAM, OIG, MOO) and state sanctions
-NPDB Monitoring to flag malpractice claims against a provider.

When expired DEAs, actions, sanctions, or exclusions are found, that information is flagged within our system. For license monitoring, we have created direct connections to all state license boards for MDs, DOs, PAs, Nurses, Mental Health Providers, and Dental Providers, and therefore automatically verify provider licenses for the universe of those providers.

Our system also automatically flags a provider if they're found on a state licensure action list. For other license types for which we have not yet attributed provider licenses and automated the process, our team or a client will access those state license boards manually, and will upload relevant reports for any providers that are on any lists. We check education via state license board in states that perform these checks, and for those that don’t we go directly to the place of education for verification.
At what frequency do you monitor?
We monitor providers on a monthly basis. This aligns with the monthly cadence at which our API intergrations to primary sources are refereshed.
How does ongoing monitoring ensure compliance?
Automated provider monitoring systems help healthcare organizations stay compliant with accreditation standards, regulations, and payer requirements. By proactively tracking provider credentials and compliance-related information, they reduce the risk of non-compliance and penalties. CertifyOS ensures compliance by monitoring provider credentials, licenses, certifications, and regulatory adherence. It simplifies tracking expiration dates, renewals, and compliance documentation for organizations.
Can I generate reports to identify out of compliance providers?
The platform provides customizable reporting features, allowing organizations to generate detailed reports on provider monitoring activities. These reports facilitate data-driven decision-making and support audits and accreditations.
How do you handle past vs. new monitoring incidents?
Our clients have access to all monitoring incidents once a provider is enrolled into the monitoring service on the CertifyOS platform. Clients have the ability to easily filter for new monitoring incidents only, in order to easily track any new flags on their providers.

MONITORING ARTICLES

See All Articles

Blog
The Power of Proactive Provider Data Monitoring in Healthcare
8/13/24
Blog
Maintaining accurate and up-to-date provider data is mission-critical; it is essential for successfully ensuring compliance and continual network quality. When provider information is current and correct, referrals are made to the right specialists, insurance claims are processed smoothly, suboptimal providers are identified, and patient care is not delayed. The urgency and significance of this issue cannot be overstated.
Blog
The Importance of Compliance in Healthcare
7/17/24
Blog
Compliance in healthcare delivery refers to adhering to laws, regulations, guidelines, and specifications relevant to health-related services. Compliance ensures that patient care is delivered safely, efficiently, and ethically. The importance of compliance and its impact on patient safety, risk reduction, improved reimbursements, and operational efficiency cannot be overstated.
Blog
Safeguarding Provider Data: The Critical Role of Network Security in Healthcare
5/30/24
Blog
One of the biggest concerns for healthcare providers is the growing number of cybersecurity threats. In 2023, there were 739 healthcare data breaches reported in the USA alone, affecting over 136.1 million patient records. The average cost of these data breaches was estimated to be a whopping $7.13 million. Along with the financial losses, the data breaches affected the healthcare sector’s ability to deliver uninterrupted and satisfactory patient care.

See All Articles

Empower your organization with automated provider monitoring solutions.

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