Manual delays
Manual credentialing caused delays, hindering expansion.
Error Prone
Managing the scale of credentialing and regulatory
updates manually led to errors.
Data Issues
Unstructured data made reporting difficult.
Growth detractor
Without integration with primary sources, every
stage of Oscar Health’s credentialing process
required manual verification, resulting in lengthy turnaround times and administrative inefficiencies.
Compliance challenges
Regulatory Inconsistencies
Oscar’s manual infrastructure couldn’t ensure timely, accurate compliance with NCQA and state policies, making audits cumbersome and leading to expired credentials (licenses, DEA certificates & board certifications) being included in their network.
Limited Monitoring
The lack of continuous monitoring increased the
risk of including providers with expired credentials
or sanctions in the network, opening Oscar to liability and potentially impacting patient care.
Inaccurate & unreliable data
Without scalable infrastructure, maintaining
accurate provider data was cumbersome, leading
to inaccuracies in directories and denied claims.
Oscar Health partnered with Certify for:
Opportunity & Results
Foundational Provider Data Infrastructure
Certify implemented real-time credentialing, drastically reducing turnaround times, allowing Oscar to quickly scale their networks. Primary source integrations and data customization added efficiency to downstream systems.
The Result?
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Reduced Credentialing TAT's to 3 days from 29.4
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Monitored > 85,000 providers
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Saved $150,000 annually in administrative costs
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Fully Credentialed > 38,000 providers
Innovative Network Integration
Certify provided on-demand file verification, reducing verification times from weeks to minutes increasing both accuracy and transparency. An intelligent monitoring system flagged problematic providers in real time, ensuring compliance and peace of mind.
The Result?
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Decreased duplicate provider issues and escalations
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Reduced wrongful file inclusion and audit fees
Comprehensive Workflow
Certify’s programmatic logic reduced Oscar’s operating expenses by enabling configurable workflows, automated recredentialing timelines, and integrated credentialing committees.
The Result?
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Reduced manual, error-prone tasks
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Enabled focus on strategic growth opportunities
- Total annual savings: 733k
Certify achieved a 29% annual costs savings for Oscar Health.
Interested in learning how Certify can help your organization achieve similar results? Book a free demo today.