Have you ever wondered why it takes months to enroll a healthcare provider with a payer? Or why does credentialing take forever? Why does it take 60 days to onboard a provider? What do all the mundane, slow processes involved in the administrative journey solve, why are they there, and are they even needed? When we began our journey in the enrollment and credentialing automation space, these were the exact questions that not only baffled us but also challenged us. The process was cumbersome and fraught with delays—a frustrating experience that seemed oddly out of place in the 21st century.

If there has been one thing constant over the years, it is change—how we work and live have all been radically transformed, and as a result, people have witnessed dramatic shifts in their experiences. After all, we went to the moon in the 1960s, sent rovers to Mars, and are on the brink of achieving AGI. Then why do these simple healthcare administrative processes are so outdated?

With a clear understanding of these issues and a strong motivation to find solutions, we chose to resolve healthcare administration head-on as our first challenge. Our first major task was to overhaul the enrollment process through our enrollment engine, Credily. This function was daunting, given its reliance on numerous third parties. Additionally, tailoring the engine to meet the distinct requirements of nearly 4,500 payers, across 150 specialties and all 50 states, involved a million unique computations. Our extensive experience powered by an active business with lots of data in this domain gave us a tremendous edge, enabling us to automate this function within a year.

Following the successful automation of the enrollment process, we turned our attention to credentialing automation. This phase was relatively easier as it primarily involved validating credentials through APIs that could pull, structure, and utilize real-time data. Our next milestone was automating the privileging process, which could minimize the manual input required from providers and committee members.

The development of these functions led to the creation of our AI-powered automation engine. This sophisticated AI engine can autonomously process complex criteria by communicating via calls, emails, and other data sources, and using dynamic logic to execute appropriate real-time actions. This was the breakthrough we were after and led to the birth of Provider Passport.