“We are fundamentally trying to change how the U.S. healthcare industry interacts with provider data.”
That was the lofty goal that Anshul Rathi, founder and CEO of provider intelligence platform CertifyOS, posited in a recent interview. All goals of course need financial wings to achieve lift off, and Rathi’s company made some progress on that target on Tuesday. CertifyOS announced the close of a $14.5 million Series A funding round led by General Catalyst.
The startup was founded last year by former employees of Oscar Health with the mission of removing friction from the provider licensing and credentialing process. CertfyOS’ leadership team has experience credentialing more than 40,000 providers over that past five years, which opened their eyes to the time and cost saving that automation can bring, according to Rathi.
“As a payer, health system or telehealth company, every time you contract or hire a provider, you have to go through a long process to bring them into your network so that they can provide care,” he said. “It takes 30-40 days and costs about $200 per provider. Most of the time, there are no APIs, no integration and no workflow automation. We are trying to reduce that time period into two minutes.”
CertifyOS has built APIs that automate credentialing, eliminating unnecessary paperwork and long turnaround times. These services are highly sought after by health systems and healthcare providers groups as clinical staff turnover rates soared amid the pandemic. The company’s technology handles cross-state credentialing for major clinician types, including physicians, registered nurses, physician assistants, nurse practitioners and licensed clinical social workers.
The funding round isn’t the only news coming out of the startup.
CertifyOS also noted on Tuesday that it has received certification as a credentials verification organization (CVO) from the National Committee for Quality Assurance. Rathi called this certification a “major mark of growth and mark of trust.”
CertifyOS sells its platform-agnostic technology to payers, health systems and digital health companies, using a mix of SaaS fees and per-provider fees. Thirty-five customers use the startup’s software for credentialing, licensing and enrollment — the two biggest are VillageMD and Thirty Madison.
Its competitors fit into two categories, according to Rathi. The first type are CVOs built for security and compliance, such as Symplr, Andros and Verisys. CertifyOS differentiates itself from these companies because it has been focused on API-powered rapid automation from the get-go, Rathi said.
“This industry has remained the same for the last 30-40 years in terms of automation,” he declared. “Companies just have big offshore teams in India and the Philippines taking screenshots, putting a PDF together, and sending it back.”
The second category of competitors that Rathi named are more “new-age” credentialling platforms, such as Verifiable and Medallion. He said CertifyOS will distinguish itself from these startups because it aims to one day become a “one-stop shop” for all matters related to provider data network management and compliance.
“We are trying to create a backend data infrastructure that acts as a single source of truth for provider data across the U.S. healthcare industry” Rathi said. “We’re building end-to-end workflow automation for anything that touches provider data — whether it’s credentialing, licensing, payer enrollment or monitoring.”