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Provider Credentialing, Re-Credentialing, and Ongoing Compliance in One Platform

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70% Faster

Credentialing cycles

Zero Missed

Credential expirations

Continuous

Compliance monitoring

Provider Credentialing, Re-Credentialing, and Ongoing Compliance in One Platform

Credentialing isn’t one step. It’s ongoing.

Most platforms treat it like a one-time task.

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Manual Verification Across Dozens of Sources

Credentialing requires checks across state boards, DEA, OIG, and specialty bodies. Each tracked separately. Each prone to delays that impact care and revenue.  

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Re-Credentialing That Catches Teams Off Guard

Three-year cycles only work if workflows start 90 days early. Without automation, deadlines slip and compliance gaps emerge. 

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Compliance Events Between Cycles

Licenses change. Sanctions happen. Without continuous monitoring, issues surface only during audits or claim denials.  

[01] Primary Source Verification

Automated Credential Verification at Onboarding

  • Verifies licenses against state medical boards, nursing boards, and allied health registries
  • Confirms board certifications through ABMS, AOA, and specialty board databases
  • Screens simultaneously against OIG, SAM.gov, NPDB, DEA, and all 50 state exclusion lists
  • Routes malpractice history, hospital privilege, and work history inquiries automatically
Automated Primary Source Validation

[02] Re-Credentialing

Scheduled Re-Verification at Every Cycle

  • Initiates re-credentialing workflows automatically 90 days before each cycle due date
  • Runs the same primary source verifications as initial credentialing with updated source data
  • Tiered expiration alerts notify providers, credentialing teams, and leadership at 90, 60, and 30 days
  • Bulk expiration reports enable proactive workload planning across your entire provider network
Complete Audit Trail Documentation

[03] Expiration Management

Track Every Credential Across Every Provider

  • Monitors license renewal dates, DEA registration expiry, and board certification windows
  • Configurable alert rules adapt to your organization's lead time requirements by credential type
  • Automated reminders to providers, credentialing teams, and leadership prevent lapses before they occur
  • Zero missed expirations across networks of any size without manual tracking spreadsheets
Intelligent Expiration Management

[04] Continuous Monitoring

Compliance Oversight Between Credentialing Cycles

  • Monitors licensure status, sanctions, and credentialing data continuously between cycles
  • Flags new disciplinary actions, DEA expirations, and board certification lapses immediately
  • Detects compliance events that a three-year re-credentialing cycle would not catch until too late
  • Automated alerts route to the right team the moment a change is identified at any source
Continuous Compliance Monitoring

Complete Documentation

  • Primary source verification records with source attribution, verification date, and next due date per credential
  • Re-credentialing packages with complete evidence for NCQA, Joint Commission, and CMS requirements
  • Expiration tracking logs documenting alert issuance, provider response, and renewal confirmation
  • Continuous monitoring records capturing every compliance event detected, alert routed, and resolution confirmed
Complete Audit Trail Documentation

FAQs

How does automated credentialing differ from manual primary source verification?

PRIME® queries official databases directly and receives responses in hours or days. Manual verification through phone calls, faxes, and mailed requests typically takes two to four weeks per source, with higher error rates from manual data entry on the return. 

When does the re-credentialing workflow initiate?

PRIME® automatically initiates the re-credentialing workflow 90 days before each provider's cycle due date. Document collection, primary source re-verification, and reviewer routing all happen within the platform, with tiered alerts escalating at 60 and 30 days if any step remains incomplete. 

Does PRIME® handle providers credentialed in multiple states?

Yes. PRIME® verifies and monitors licenses independently across every state where a provider holds an active license, with each jurisdiction's requirements tracked separately and alerts issued per credential rather than per provider. 

What compliance standards does the documentation support?

PRIME® generates audit-ready documentation for CMS Medicare and Medicaid requirements, NCQA credentialing and re-credentialing standards, Joint Commission primary source verification requirements, and state-specific jurisdiction timelines. 

How does continuous monitoring relate to re-credentialing?

Re-credentialing is a comprehensive point-in-time verification that runs on a defined cycle. Continuous monitoring is what protects your organization between those cycles, catching sanctions, license lapses, and disciplinary actions before they affect patient care, payer standing, or claims processing.