CertifyOS, a supplier information intelligence firm, has launched a brand new platform to assist payers handle supplier information of their community, the corporate introduced final week.
New York Metropolis-based CertifyOS serves well being plans and digital well being firms and is working to streamline entry to supplier information, whether or not that’s for supplier directories or medical claims. Its new AI-powered platform, known as the Supplier Hub, takes information from a spread of sources — credentialing, directories, claims, rosters, and so forth. — and cleans it and unifies it right into a single file for payers.
The platform integrates immediately with downstream methods, comparable to contracting, directories and claims methods. It identifies when there are gaps within the information and flags points to assist assist decision-making. As well as, it constantly screens supplier information and sends alerts on outdated information.
The brand new Supplier Hub is important as a result of each a part of healthcare operations — together with cost integrity claims, member expertise and supplier directories — is impacted by inaccurate supplier information, in line with Anshul Rathi, founder and CEO of CertifyOS. The healthcare trade spends about $3 billion a 12 months to manually replace supplier directories.
“What now we have as we speak is dozens of supplier information groups choosing up the cellphone, calling the suppliers and sustaining their very own system of document. So even throughout the group, if a crew has up-to-date supplier information, it’s not transmitted to different elements of the group,” he mentioned.
“We consider that is without doubt one of the largest causes of irreversible administrative prices within the U.S. healthcare trade,” he continued. “There needs to be a central hub that’s so linked with all these disjointed sources and the suppliers themselves, that any change by the sources, within the sources or by the suppliers is mirrored within the information supply, making it a de facto supply of fact. That’s what Certify’s Supplier Hub is.”
Rathi added that CertifyOS already has about 30 payer clients for this platform, together with nationwide plans and Medicare Benefit plans. Nonetheless, he declined to call particular clients. Payers pay a charge for the platform, with a subscription on high of that.
The launch of the Supplier Hub comes shortly after CertifyOS raised $40 million in Sequence B funding in June. That funding helped assist the creation of this new platform.
In the end, CertifyOS goals to “essentially change how U.S. healthcare interacts with supplier information,” Rathi mentioned.
“The objective is that sufferers have an amazing expertise,” he famous. “In the event that they go to a physician, their insurance coverage is accepted, the docs truly work there, they usually don’t should chase the insurance coverage firms with claims. … That’s an enormous a part of the affected person expertise general with what we’re doing. On the similar time, we consider that the supplier shouldn’t be spending their time filling the identical utility a number of instances or getting contracted with a number of payers a number of instances.”
Picture: Yuichiro Chino, Getty Pictures
