Eliminate Ineligible Claims and Reduce Overpayment

Proactively stop payments to bad actors before they head out your door.
List of providers showing compliance

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.

Illustration of a dashboard with a photo of someone looking at a computer and a file with the capital behind them
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

Data Accuracy and Integrity Built to Scale

Explore our monitoring and verification solutions, specially 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.
ProviderTrust's platform for license and credential monitoring

License and Credential Verifications

Our NCQA-accredited automated primary source verifications and ongoing license and credential monitoring ensure that every provider has the required credentials to serve your patients.

Go beyond regulatory requirements with ease.

Data Security

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

Network Accuracy
Prioritize patient safety and access beyond initial credentialing.
Reporting and Documentation

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

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Related Resources

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