Category: Provider Data Management


Medicare is forging ahead with a payment program that links physician pay to measured quality of care. “This could be the beginning of baseball-style score cards for physicians,” says Dr. Garry Choy, radiologist and chief compliance officer at CredSimple. “Instead of tracking RBIs and home runs, physician reports cards will track patient outcomes.” The idea […]

Fact: Your business runs on data. That data affects your business every day. Obsolete provider data is an industry-wide problem. It’s likely that a good portion of your data is already outdated, and another 2% will become outdated every month, making it less useful to you and your members every month. You wouldn’t be okay with your […]


Implementation of new technology can seem like a burden, which is why we’ve been purposeful with how we’ve built CredSimple. Our goal is to unburden the credentialing process and to make implementation and use of our platform as efficient as possible. There are 2 distinct but interrelated ways our clients can use our platform: As […]

Your provider credentialing process directly affects your organization’s bottom line in numerous ways. It’s worth considering now whether your credentialing function is a headwind or a tailwind on revenue. Here are 3 ways to mind how it affects your business: #1 — The Accuracy and Usefulness of Your Provider Data Networks and providers are constantly changing. […]

Why is Jessica so Frustrated? Jessica is a busy credentialing coordinator who has been in her role for 5 years. Today, she arrives at her desk to voicemails and emails from the provider relations department requesting status updates on credentialing for their new providers. By lunchtime, she has received more status requests. Every time she […]


Disruption is happening in every industry these days. To be hailed a “disrupter,” a company must challenge the status quo. One way to do that is to question industry assumptions. It takes a bold and forward-thinking company to take on entrenched “we’ve always done it this way” practices, especially in a highly regulated industry like […]

Provider directories are an important resource for network management and referral management. They are also an important tool for healthcare consumers. Provider directories are one of the first, and most important, gateways in a consumer’s healthcare journey. For all these reasons, we wanted to know more about what healthcare consumers think about provider directories. So […]


Provider directories have long been a source of inaccurate provider information. As a result, federal (CMS) and state regulations will be enforced to ensure that healthcare consumers receive accurate information. Failure to comply with these specific state regulations will result in certain penalties. Stemming from work with health plans throughout the United States, our compliance […]


Provider data is the foundation of a healthcare network, and bad data causes ripple effects that add up to billion-dollar problems across the entire industry. These problems affect doctors, their practices, the payers that have to reimburse claims and manage a huge amount of complexity, and even patients. We’ve written about the problems that poor […]

Founded in 1990 with the mission to systematically improve healthcare quality, NCQA is considered the gold standard when it comes to credentialing requirements. We think it’s important to understand and get the most out of the NCQA credentialing requirements. In this post, we’ll explore the six common mistakes we’ve seen healthcare organizations make as they endeavor […]