Resources

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 to come.

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.

Carla Simmons joined Certify in March 2022 and was promoted to Director of Operations in January 2024. She graduated from Tennessee State University with a BS in Cardio-Respiratory Care Science. Her previous employers include Humana and Centene Corporation. While she was born in Toronto, Carla grew up in the Bronx in New York City. Currently, she lives in Metro-Atlanta with her husband and 2 young adult children. Outside of work, Carla loves all things Arts & Crafts, as well as traveling and volunteering in her community. Carla also enjoys spending time with her family, especially with her twin sister.

Zoltan joined Certify in February 2024 as Sr. VP of Engineering. Zoltan brings a wealth of experience and passion to his role through a diverse background, including serving as a Water Polo Timing Official at Aragon High School in San Mateo, CA and coaching rowing from 2002 to 2003. Zoltan lives with his wife, 3 children, 2 cats, and dog in California. He recently participated as a panelist at HiPaaS 2024, showcasing his commitment to advancing the future of AI in healthcare.

In the complex world of healthcare, the relationships between payers and providers can often become strained. This strain, commonly referred to as "provider abrasion," signifies the friction that can arise from misunderstandings, miscommunications, and procedural inefficiencies. These challenges can impact the efficiency of care delivery and the overall satisfaction of both providers and patients. In this post, we will delve into the concept of provider abrasion and explore effective strategies to reduce it, fostering smoother and more productive collaborations in the healthcare ecosystem.

Provider credentialing is a multi-step process healthcare systems and plans use to verify healthcare providers' qualifications and competency before granting network inclusion or clinical privileges. This process ensures that clinicians are vetted and compliant with state and federal regulations. It applies to providers intending to get in-network with health plans or employed and affiliated practitioners of health systems.

Provider network adequacy is critical for compliance and patient care because it ensures that patients can access sufficient healthcare providers and services within a reasonable geographic distance and wait time. Adequate networks deliver the following: