Stop Pay-and-Chase with Proactive, Frontend Eligibility Checks

Eliminate ineligible claims and reduce overpayment, proactively stopping payments to bad actors before they head out your door.

List of providers showing compliance
In a short period of time, ProviderTrust’s guidance and expertise has simplified our day-to-day operations and improved our overall business, but more importantly, it’s allowed us to focus on achieving our mission ‘To Improve the Oral Health of All.'"

Liza Morris

Provider Operations Manager

Reimagine Your Claims Editing Process, Identifying Bad Actors Pre-payment

Ineligible claims are more than a setback. They directly impact your organization’s bottom line. We partner with you to catch exclusions and invalid licenses  pre-payment — providing continuous, always-accurate network eligibility insights to halt faulty claims before they process.

Reduce Overpayment and Wasteful Spending

Overpaying claims and trying to recoup later is inefficient
Between $68 and $226 billion is lost annually to Fraud, Waste and Abuse (FWA). With provider network monitoring that is both continuous and always accurate, you can spot claims from ineligible providers before they are paid.
Claims recovery efforts are costly
Traditional methods of claims recovery can quickly escalate the cost of the claim. Our primary source data monitoring and matching algorithms spot potential FWA faster and deliver the documentation and evidence you need for hand off.
compliant employee getting approval to be paid through the ProviderTrust platform
List of providers showing compliance

Ensure Compliance in a Shifting Regulatory Environment

Maintain an up-to-date directory of eligible providers
With continuous monitoring of eligibility requirements, your team can spot provider ineligibility among your network in real-time, providing critical insights for both your par and non-par provider directories.
Defend the integrity of your government LOBs

With monitoring that is both smarter and faster, you can catch exclusions and other issues hiding in your provider network among par and non-par providers alike.

Simplify Administrative Complexities and Workflows

Adjust your claims editing process to include eligibility pre-checks

Why wait until post-payment to identify provider network eligibility? Our always-accurate intelligence provides simplified insights about your provider network, empowering your team to remove bad actors before the claims editing process even begins.

Connect your system of record via seamless and secure integrations

Speed to action is critical for pre-payment screening. We’ve designed our provider network monitoring to deliver fully verified eligibility alerts weeks (or months) before any other solution. Access your provider insights in your system of record through our seamless and secure API integrations.

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Thoughtfully Curated for Your Organization

One powerful monitoring and verification platform, designed with Payment Integrity in mind.

ProviderTrust's platform for provider network monitoring

Provider Network Monitoring

We deliver healthcare’s most comprehensive compliance intelligence platform for provider eligibility and continuous compliance.

API Integrations

Healthcare’s most powerful APIs and integrations for instant compliance verifications across your workflows.

Innovated for intelligence. Handcrafted for humans.

Data Security

Ensure SOC II and NCQA-certified security standards and controls.

Primary Source Verification

Verify every license and credential for all providers directly at the primary source.

Reporting and Documentation

Always be audit-ready with primary source documentation for every provider.

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Related Resources

Let’s do better together. Simplify your healthcare compliance.

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