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For health plans, maintaining accurate provider information is essential for regulatory compliance and claims processing. Delegated credentialing serves as a valuable strategy to offload administrative tasks, but it also creates new challenges. While delegated entities manage their provider rosters by verifying and monitoring providers, a significant issue arises when these entities return rosters in incomplete, inconsistent, or incompatible formats. This creates a substantial burden for health plan teams who must manually clean, validate, and ingest this data into their specific data schema and format that drives downstream business processes.

Credentialing is an essential part of enrolling your providers in new health plans so you can tap into new patient markets. But it also involves many time-consuming verification steps and strict regulatory requirements—and you’re often stuck waiting on payers to handle them.

The landscape of 21st-century medicine is shifting more rapidly than ever. This is certainly the case for digital health. While technology enables health care practitioners to practice across state boundaries, licensing structures have not evolved fast enough to keep up. Individual U.S. states or territories issue these licenses, and the process must be completed for each state where a provider intends to practice. Navigating this landscape is complex and expensive. Nevertheless, ensuring that healthcare providers meet licensing requirements is essential to delivering safe and compliant care in this changing environment. This guide will help digital health companies navigate the complexities of medical licensing to ensure compliance across state lines.

Our interviewee, Juliana Van Daele, brings a wealth of experience and a diverse background to Certify. Originally from Manhattan and raised in New Jersey, she attended Santa Clara University, where she earned a BA in Communications and Art History and competed on the lacrosse team. Her career includes positions at prominent organizations such as Google, Babylon, Genentech, and Sword Health, where she honed her skills and earned a Project Management certification. She has lived in London, Brazil, and New York, but currently resides in Newport Beach, California, with her husband, their new daughter, and their two dogs, Moses and Jude.

Certify was thrilled to have Mitchell Gorodokin, VP of Business Development, appear on the Becker's Payer Issues Podcast live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable in Chicago. Gorodokin talked with host Gracelyn Keller about strategies for enhancing provider data workflow efficiency as well as laying out tactical advice on improving business infrastructure to ultimately drive growth. Read the interview below or listen to the podcast on Spotify or Apple Podcasts.

As we begin 2025, the credentialing and provider data industry faces challenges and opportunities that will shape its future landscape not only this year, but for years to come. As CEO and founder of Certify, I am in a unique position to see how technological innovations and evolving customer needs together are driving toward exciting changes.

Nick Helfrich joined Certify as Chief Growth Officer in April 2023. A native of Waterloo, Illinois, he holds a BSBA in Business Management and Political Science from Rockhurst University in Kansas City, Missouri. His leadership experience in the healthcare sector began at Cerner Corporation in 2011, where he progressed from Client Executive to Director of Sales for CommunityWorks. Throughout his career, Helfrich has held executive leadership roles, developing and maintaining strong relationships with a wide range of organizations, including digital health companies, managed care organizations, health systems, and employers.

The 2024 HiPaaS Healthcare AI Conference in Burlingame, CA, brought together leaders in healthcare technology to discuss the latest advancements and challenges in artificial intelligence for the healthcare industry. The Healthcare AI panel included Nitin Shingate, Chief Technology Officer at GoodRx; Sandeep Deokule, Founder and CEO of HiPaaS Inc.; and our own Zoltan Gombosi, Senior VP of Engineering at Certify. In this blog, hear from Zoltan Gombosi as he discusses generative AI's current applications, future possibilities, and crucial considerations for responsible implementation within the healthcare industry.