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Provider Network
Monitoring
Be confident in your providers with set-it and forget-it compliance that ensures your provider network will not pose an additional risk due to malpractice, legal penalties, or disciplinary actions.
Automated Provider Network Monitoring for NCQA Compliance and Beyond
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Easily Enroll Providers in Ongoing Monitoring
Add newly credentialed providers to your preferred monitoring program with one-click.
Tackle Compliance Audits with Confidence
All monitoring sources are tracked with historical activity logs, so no detail is missed.
We've Got You Covered with
3,200+ Available Sources
State Licenses
Never get caught off guard by a license expiration again–Verifiable directly connects to 200+ state and national license sources for provider types including:
- Counseling/Therapists
- Dentistry
- Medicine
- Nursing
- Optometry
- Pharmacy
- Psychology
- Social work
- Speech pathology
- and more....
SAM
Dodge potential fraud by checking your provider network against SAM’s list which includes individuals and entities who have been debarred, sanctioned, or excluded by a federal agency.
DEA
Prevent drug misuse and fraudulent prescriptions by ensuring the providers in your network are properly registered and not under investigation with the DEA.
NPDB
Access continuous query to get notified of new flags on your providers within 24 hours of the adverse action being reported. NPDB maintains information on the following:
- Medical malpractice payments
- Federal and state licensure and certification actions
- Adverse clinical privileges actions
- Adverse professional society membership actions
- Negative actions or findings by private accreditation organizations and peer review organizations
- Health care-related criminal convictions and civil judgments
- Exclusions from participation in a Federal or state health care program (including Medicare and Medicaid exclusions)
- Other adjudicated actions or decisions
OIG
Avoid costly civil monetary penalties by ensuring your providers are not listed on OIG’s List of Excluded Individuals/Entities – making them excluded from reimbursement via medicare, medicaid, or other federal programs.
State Sanctions and Exclusions
Comply with federal regulations by ensuring your provider network does not include individuals who have been disciplined or lost license privileges from their state’s specific enforcement agency–as this is cause for termination according to Section 6501 of the Affordable Care Act.
Medicare Opt-Out
Avoid potential billing issues and penalties by knowing which providers in your network have chosen not to receive reimbursement from medicare.
NPI
A standard set forth by HIPAA for the administrative simplification of financial transactions, a provider’s NPI should be regularly verified to avoid unexpected billing delays.
OFAC
Ensure the physicians you hire and the partners you work with are considered safe and trustworthy.
SSA-DMF
Steer clear of fraudulent providers by conducting regular checks of your network against the social security administration's official list of deceased persons.
How Does Ongoing Monitoring Work?
Ongoing Monitoring
- “Listens” for changes from sources on a continuous basis
- Alerts you in real-time of any flagged providers
- Same-day alerts for any at-risk providers
Frequency Monitoring
- “Scans” for changes from sources on a set schedule (typically monthly)
- Alerts you based on set schedule of any flagged providers
- Potential 30-day delay for alerts on at-risk providers