Case Studies

Health System Enhances NPI Validation and Referral Monitoring


The following case study is an example of a ProviderTrust customer who is a large metro health system in the southwest United States. This customer has been a partner since 2017 and has expanded their team’s operations to include multiple PT solutions in their compliance tech stack.

Health System Profile

This customer is a large health system provider with many locations and a wide range of healthcare services including urgent care, primary care, home health, mental health services, and more.

This organization has partnered with ProviderTrust to monitor a variety of healthcare populations – clinical staff, employees, vendors and owners, and referral providers who order and prescribe.

In our Passport solution, this customer conducts ongoing exclusion and sanction monitoring for around 29,000 employees and medical staff. In addition, this healthcare organization has a vendor population of 12,000, which they must monitor against exclusion databases and CMS eligibility requirements.

To complete their comprehensive monitoring package, the customer has a need for ongoing NPI validation and monitoring for their large referral provider networks of around 34,000 clinicians.


The Challenge

The customer was looking to find a data partner who could scale with their growth and easily add any sources they needed for ongoing monitoring of their provider networks, internal staff, and third-party vendors. It was important for their team to incorporate a more unique and customized way of monitoring a large population of referring, ordering, and prescribing physicians.

It is crucial for health systems to ensure that all referring, ordering, and prescribing providers are verified and monitored to remain compliant and avoid any fines or penalties. We’ve found that many teams are continuing to validate by name alone and continually search online databases for potential matches.

This process is inefficient and can produce faulty results, leaving organizations vulnerable to misinformed decision making and bad actors who may pose a risk to patient safety. In most cases, with NPI validation and smarter monitoring, Compliance teams can fill in data gaps from referring providers in a matter of seconds.

With so much disparate data involved in this process, it was important for the customer to have a monitoring environment that could be easily configured to their needs and terminology for their provider networks. 


Partnership Goals

  • Validate NPI records in Dash and return current provider status (Active, Valid, Deactivated, Not Found)
  • Remove name-only verification and optimize their team workflows for referring, ordering, prescribing providers
  • Utilize ProviderTrust solutions for a comprehensive suite of ongoing monitoring capabilities
  • Establish trust with an exact-match solution that is reliable and identifies areas of risk and concern
  • Reduce additional verification or false-positives for excluded or sanctioned providers, employees, and vendors
  • An intuitive platform that can easily be adopted by team members and utilized by administrators for high-level results
  • Centralize provider data and ongoing monitoring records
  • Monitor healthcare providers, employees, vendors for any exclusions or sanctions from HHS OIG,, or state Medicaid authorities
  • Optimize team workflows with aligned policies, controlled processes, and increased accountability
  • Create dashboard views to meet compliance and reporting requirements


How We Helped

  • Implemented and onboarded their team with our Dash solution for referring, ordering, prescribing providers
  • Returned 235 NPI inactive alerts
  • Identified 93 federal healthcare exclusions
  • Found 75 state excluded, sanctioned, or terminated providers
  • Increased operational efficiency for evaluating employment lifecycles, scheduling tasks, supply chain management, and provider network verification and ongoing eligibility monitoring
  • Automated monthly exclusion monitoring for clinical staff, employees, and vendors with exact-match results
  • Successful onboarding and team adoption with optimized workflows and reporting
  • Shared insights and transparency for their team for multiple populations
  • Enhanced reporting options for smoother audits and quick lookup of provider verification and monitoring history
  • Provide best-in-class customer service for their team to identify risks and opportunities to improve


Customer Highlight

We are so pleased with our partnership with this customer and continue to learn from their unique challenges and opportunities each day to help address the needs of patients and healthcare organizations. ProviderTrust aims to make their lives a little easier by providing helpful tools and customer service for increased clarity while onboarding and monitoring provider populations, employees, and third-party vendors.

Our team celebrates their success in having a trustworthy process to quickly alert and align their focus when compliance issues arise in any of their healthcare populations.

ProviderTrust continues its mission to create smarter and safer healthcare by empowering healthcare professionals with automated solutions that impact patient care on a daily basis.


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