Provider credentialing is often a manual and time-consuming process, and each day that a physician is not seeing patients is lost revenue to the organization.
Credentialing a single provider typically takes between 90 to 120 days. The average revenue loss from credentialing delays is $6,000 to $8,000 per provider monthly, according to some estimates.
Startup Assured sees big opportunities to use artificial intelligence to speed up provider credentialing, licensing and payer enrollment.
The company, which launched last year, offers an AI-powered platform for provider network management that was built for healthcare organizations to onboard providers and scale across states and payers.
Assured says its platform is the first National Committee for Quality Assurance-certified network management system that can fully credential a provider in two business days, compared to the typical timeframe of two to four months. The technology also gets most providers in-network 15 days faster than traditional processes, according to executives.
"Inherently, Assured exists to enable providers to see patients faster," Rahul Shivkumar, co-founder and director of Assured, told Fierce Healthcare. "Today, what we've seen with a lot of the organizations we work with is that provider credentialing piece is done extremely manually. People are using spreadsheets and they're doing everything sequentially."
Assured's technology can automatically verify credentials across more than 2,000 primary sources in parallel, Shivkumar said. "In real time, we can verify that someone is actually licensed somewhere, that the license is valid and there's no sanction against it, and we're able to do it in parallel. That's able to significantly reduce the time it takes to credential providers."
In the last year alone, Assured has processed tens of thousands of enrollments and saved its customers hundreds of hours each month, executives said. The startup is growing 30% month over month.
Assured's technology also reduces the error rate when submitting applications to payers to cut down the payer enrollment timeframe, Shivkumar said.
Assured pocketed $6 million in seed funding, led by First Round Capital with participation from Kindred Ventures, Bragiel Brothers, and the founders of Atria and Grow Therapy.
The company plans to use the funding to build out its AI capabilities and expand its team. "We are going to invest a lot in R&D. We've built some use cases that are fully autonomous and we want to build more. Our customers and prospective customers have a laundry list of requests from us. A lot of the funding is going towards building out that team and also expanding sales and marketing," Shivkumar said.
"Provider operations are healthcare's most overlooked infrastructure problem," said Bill Trenchard, partner at First Round Capital. "Assured built the intelligence layer that healthcare needs to scale. Their combination of deep domain expertise and AI automation doesn't just solve today's bottlenecks. It fundamentally rewrites how provider networks grow."
The company developed an AI-native network management platform that compresses months of manual processes into days of automated workflows. Assured built the infrastructure to automate every step from primary source verification to enrollment submission while maintaining the compliance, auditability and payer relationships needed to operate at scale, executives said.
Assured works with more than 100 customers, including major health systems like Houston Methodist and digital health companies like Blossom Health and Tono Health.
Health systems are quickly seeing the value of automating these processes, Shivkumar said.
"If they're able to get someone in network faster, they're able to bill patients faster, because they all have wait lists of patients waiting for certain specialists. When we give them that revenue activation, a lot of them move very quickly. Our first health system deal took only four months. We're seeing a lot of momentum there and a pull from the market, and the outcomes really are being able to onboard these providers significantly faster," he said.
Assured aims to work with independent physicians and small practices. "The way to scale it out is to have a really good self-serve experience and really good technology that's able to do it by itself versus staffing people. I think our long-term vision is basically give this superpower to everyone so they don't have to worry about the administrative burden," he noted.
The paperwork involved with provider credentialing is a major pain point for health systems, practices and digital health companies, and Shivkumar experienced these operational issues first-hand when he and Varun Krishnamurthy launched Dawn Health in early 2021. Dawn Health is an on-demand virtual sleep clinic that Shivkumar and Krishnamurthy scaled to 150 providers across 15 states. It was acquired by Health Care Originals in 2023.
"Getting providers credentialed with payers was slow, manual and error-prone. Data was fragmented across dozens of systems and formats, and every payer had different requirements with lengthy review cycles that stalled onboarding. Every delay meant lost revenue and patients waiting longer for care. We quickly realized that this problem was decades old and not unique to us," Shivkumar wrote in a blog post.
Older legacy vendors in the provider credentialing space often still rely on manual labor to do the administrative work.
"It was difficult to keep quality scaled on the vendor side. For us, the fundamental reason to start this company was that technology shift, the ability to actually build autonomous agents that can handle an entire workflow, not just be a nice software layer with a human being actually doing the work on the other side," Shivkumar said.
He added, "That's the vision that we're building towards. We have humans in the loop right now that are obviously correcting, and any data that goes out, there's still a human being still looking at it. I think longer-term, our vision here is fully autonomous agents that keep the quality high and can still operate very quickly."
There are a number of companies using AI to tackle credentialing verification and provider network management. Last month, medical licensing and credentialing platform Medallion announced a $43 million funding round, bringing its total fundraise to $130 million. The startup says its platform supports approximately 1 million providers, or about 10% of the U.S. healthcare workforce. Medallion also publicly launched CredAlliance, a shared credentialing infrastructure for payers.
Baton Health also uses technology to take the manual data entry out of credentialing and raised $8.75 million a year ago.
Startup Certify is building a modern data infrastructure that unifies provider data across sources and systems. The company aims to provide a single source of truth for provider data, company executives said. The startup banked a $40 million series B funding round back in June.