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Credentialing is one of the most important—and resource-intensive—administrative functions for payers. Before a healthcare provider can join a network, insurers must verify their qualifications, licenses, training, work history, and other relevant credentials. Done manually, this process can be slow, costly, and prone to errors, adding to an already daunting and messy provider data maintenance process.

The volume of services delivered has long measured the value of healthcare: the number of tests ordered, procedures performed, or patients seen. This fee-for-service model has fueled rising costs without consistently improving patient outcomes. In response, payers, providers, and policymakers have been shifting toward a new framework: value-based care (VBC).

For too long, healthcare organizations have been held back by fragmented data and manual processes. The tools meant to help—clunky portals and disconnected software—often become little more than digital filing cabinets, creating more administrative work than they eliminate. This legacy approach, built on manual data entry and periodic checks, is no longer sustainable. It’s slow, prone to error, and creates a significant drag on efficiency and compliance.

In early 2025, McKinsey released a report claiming that by 2030, more than 30% of U.S. jobs will be automated and 60% significantly transformed by the use of AI. Ray Daloio, founder of the Bridgewater Hedge Fund, says he has started to worry about a “great deleveraging” where technology innovations outpace the speed at which new human roles emerge, leading to a massive impact on our economy.

At first glance, provider data management appears to be a relatively straightforward endeavor: Health plans regularly collect and update provider information, aligning with regulatory requirements, ensuring that patients have access to high-quality care, and that providers are paid on time.

Healthcare is drowning in data—but not the good kind. Siloed databases, fragmented records, and redundant point solutions make it harder than ever to keep provider information accurate and up to date. The result? Administrative burdens, higher costs, and slower onboarding for providers who just want to deliver care.

The Centers for Medicare & Medicaid Services (CMS), backed by the White House’s tech brain trust, recently made a game-changing announcement—directly aligned with the future of Certify’s provider data management approach. The vision is to create a centralized, API-powered National Directory of Healthcare Providers and Services (NDH) that brings order and intelligence to the complex and fragmented world of healthcare data.

In our high-tech world, where AI can support doctors in narrowing down complex diagnoses and tech-forward infrastructure can streamline even the most archaic processes, it’s surprising that many hospital systems and payers still use legacy technology (or no technology at all!) to accomplish routine administrative tasks.