Provider profile maintenance
One source of truth per clinician: training, licences, work history, references and disclosures.
13 · Back office & compliance
AI Credentialing Agent
Credentialing is relentless rather than difficult: the same forms, slightly different, with deadlines that quietly destroy revenue when missed. The agent does the chasing so nothing lapses.
Agent at a glance
- StatusIn development
- CategoryBack office & compliance
- Deployment2–4 weeks, shadow mode first
- Review modelHuman approval per action, configurable
- Headline metric0 Lapsed expirables
- EvidenceFull action log, exportable any time
0
Lapsed expirables
Licences, DEA, board certifications, malpractice and CAQH attestations.
60–90
Days to enrolment
Tracked and escalated daily rather than waiting in a payer inbox.
< 5 days
Application build
From provider intake to a signature-ready application.
What it does
Everything in this agent, in writing.
Application prefilling
Payer, hospital and Medicaid applications completed from the profile, with only signature and attestation left to the provider.
CAQH and NPPES upkeep
Profile build, document upload, attestation cycles and NPI record accuracy.
Payer follow-up
Fixed-cadence status checks with reference numbers recorded and escalation paths per payer.
Expirables surveillance
Every dated credential tracked with 120/90/60/30-day escalation to the provider and the practice.
Roster and directory accuracy
Payer directory audits so patients find you, claims route correctly and departed providers are removed.
Deployment
Live in weeks, not quarters.
01
Credential inventory
Every provider, every payer, every dated document — into one tracked register with its current status.
02
Profile build and verification
Source documents verified and the master profile created.
03
Gap closure
Expiring items, missing attestations and stalled applications worked to resolution.
04
Continuous monitoring
Automated expiry tracking, revalidation calendars and monthly status reporting.
Guardrails
What it will never do.
These limits hold regardless of configuration. They exist so that you can put an agent in front of patients without putting your licence next to it.
- Never submits an application or attestation without provider review and signature
- Primary-source verification for licences and certifications, not self-reported data
- Credential documents stored encrypted with access limited to named staff
- Escalation to the practice before a deadline is missed, not after — 120 days out
- Complete audit trail of who submitted what to which payer, and when
Human in the loop, by your choice
Every action can require approval before it commits. Start with all of credentialing agent queued to your staff or to ours, watch the accuracy numbers, then widen autonomy workflow by workflow — or leave it queued forever. Both are supported.
Escalations land with certified people
Our review queue is staffed by the same certified coders, billers and credentialing specialists who run our managed services. Not a support desk, and not a chatbot watching a chatbot.
Full evidence trail
Input, decision, action, confidence, model version, reviewer and timestamp — retained and exportable as CSV or JSON, including after you leave us.
What we report against
Operational targets for this agent. They are internal commitments measured on your own data, reported monthly — including the misses.
0
Lapsed expirables
60–90 days
Enrolment time
< 5 days
Application build
100%
Expirables tracked
Works with your systems
Your EMR, your numbers, your data.
- CAQH ProView
- PECOS
- NPPES
- State Medicaid portals
- Payer provider portals
- Hospital privileging systems
We integrate through FHIR and HL7 where the vendor supports it, and through secure automation or structured document intake where it does not. No API required, no vendor commission taken.
FAQ
Common questions.
Can it complete payer applications end to end?
It completes everything except the provider's own signature and attestation. That signature is a legal act and stays with the clinician.
How does it handle primary-source verification?
Licence and certification status is verified at the issuing board or registry, with the verification date and source recorded. Self-reported credentials are never treated as verified.
What happens when a payer stalls?
The agent follows a fixed cadence, records reference numbers and escalates through the channels that actually work for that payer — provider relations, network representatives or a state insurance department complaint where warranted.
Does it cover hospital privileging?
Yes — privilege applications, delineation of privileges, references and reappointment cycles, managed alongside payer enrolment so the two never contradict each other.
Related agents
Usually deployed together.
01
In development
AI Phone Agent
Answers every call on your existing number, day or night. Books and moves appointments in your EMR, captures refill requests, answers routine questions from your own practice information, and leaves staff a transcript plus a task.
- 24/7 answering on the number patients already call
- Books, reschedules and cancels directly in your EMR
- Transcript, intent and task attached to the patient record
02
In development
AI Web Chat Agent
Turns website visitors into booked appointments. Answers questions from your own practice information, checks provider availability, and hands the visitor a real appointment instead of a contact form.
- Books appointments from your website, 24/7
- Answers questions from your content, not the open web
- Escalates to staff with the full conversation attached
03
In development
AI SMS Agent
Two-way text that confirms, reminds and refills the schedule. Handles replies like 'can I move it to Thursday', keeps a TCPA-compliant opt-out record, and fills cancellations from your recall list.
- Confirms and reschedules by text, automatically
- Fills cancellations from your waitlist in minutes
- TCPA-compliant consent, opt-out and quiet hours
See it run on your own workflow.
A 30-minute demo using your scenarios, your payer mix and your systems. We will show you the guardrails and the audit log, not just the happy path.
A 30-minute call with an operations lead. No obligation, no sales sequence, and we will say so if you do not need us.