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Transform Provider Lifecycle Management with Connected, Compliant, and Automated Workflows

Enterprise Automation for Network Adequacy, Contracting, Credentialing, Roster Files, Data Management, and Claims Configuration
Automate provider workflows from network adequacy to roster filing to claims configuration—eliminating manual steps, improving data quality, and increasing reimbursement and directory accuracy.
Provider1™ streamlines all critical functions in the Provider Lifecycle and can deliver value as an end-to-end or through module that address your urgent business need.
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Build Intelligence into Every Step of the Provider Lifecycle

Modular or End-to-End Approach to Solving your Business Challenges with a Flexible, Intuitive, and Efficient Solution
Data Guardrails. Automated Workflows. Business Rules. Configurable for You.

Competitive Provider Network Insights

Build and Maintain High-Performing, Compliant Provider Networks

Leverage AI-powered intelligence to evaluate network adequacy, benchmark provider rates, and identify strategic gaps—empowering payers to strengthen access to care while staying compliant.

  • Network Adequacy Analysis
    Assess coverage gaps by specialty and geography using CMS-aligned benchmarks.
  • AI-Powered Benchmarking
    Use machine learning models trained on 67 TB of CMS data to detect deficiencies and recommend improvements.
  • Competitive Rate Comparison
    Compare provider-negotiated rates against market benchmarks to refine network strategy.

Contract Lifecycle Automation

Create a Master Record for Provider Data

Unify and govern provider data across the enterprise to reduce redundancies, improve accuracy, and ensure compliance across directories, claims, and contracting systems.

  • Intelligent Provider Master Record
    Define complex provider hierarchies across organizations, locations, and practitioners using configurable data models.
  • Data Cleansing and Quality Enforcement
    Apply robust cleansing utilities and guardrails to continuously maintain high-quality, deduplicated provider records.
  • Network Affiliation Mapping
    Associate providers with networks and automatically cascade affiliations to connected entities.
  • Provider Insights and Adequacy Evaluation
    Analyze machine-readable transparency files to uncover network adequacy gaps and benchmark network competitiveness.

Contract Lifecycle Automation

Digitize and Standardize Provider Contracts for Professional, Ancillary, Facility ...

Manage standard and custom contracts and amendments with templates and workflows that enforce your business rules and processes – while delivering a faster process.

  • Centralized Contract Repository
    Migrate and standardize contracts, amendments, clauses, and exhibits into a searchable, structured format.
  • Configure Fees and Rates
    Manage and maintain fees and rate tables for all contract types including fee-for-service and value-based models.
  • Negotiation and e-Signature Support
    Enable in-app redlining, build custom negotiation models, and streamline execution with embedded electronic signature capability.
  • Audit Trails and Financial Reporting
    Track every change and generate financial, quality, and utilization reports to maintain transparency and compliance.

Credentialing and Monitoring

Integrate with Your CVO or Bring Credentialing In-House with a Streamlined Solution

Streamline credentialing with automated PSV, integrated workflow, and ongoing monitoring—ensuring readiness, reducing risk, and enabling faster provider onboarding.

  • AI-Enabled Primary Source Verification (PSV) Automation
    Auto-capture verification evidence, maintain a centralized PSV library, and integrate with downstream systems.
  • Committee Review Workflow
    Classify cases into routine vs. non-routine for faster processing and enable electronic committee review and approvals.
  • Automated Document Generation and Storage
    Generate approval or denial letters automatically, and store all supporting documents, correspondence, and PSV evidence in a searchable format.
  • Recredentialing and Sanction Monitoring
    Continuously monitor credential status, automate recredentialing workflows, and track sanctions with task assignments and provider notifications.
  • NCQA Compliant
    Ensure compliance with NCQA requirements.

Roster File Intake and Loading

Streamline Roster Intake with End-to-End Automation

Automate the Roster File intake to eliminate manual file mapping and management.

  • AI Enabled Roster File Standardization
    Ingest provider roster files in various formats and convert them into a standardized structure.
  • Data Repository Update
    Data repository additions, updates, terminations are automated per the business rules and workflow configured to your needs.
  • Load Roster Files with Business Rules Applied
    Apply business rules to roster files to ensure clean records are loaded and exceptions are handled.

Centralized Provider Data Management

Create the Authoritative Source for Provider Data

Unify and govern provider data across the enterprise to eliminate duplicative data sets, streamline operations, and ensure accuracy for claims systems and directories.

  • Intelligent Provider Master Record
    Configurable hierarchies and data attributes allow you to manage your business as you require.
  • Guardrails Enforce Data Quality
    Apply robust cleansing utilities and guardrails to continuously maintain high-quality, deduplicated provider records.
  • Network Affiliation Mapping
    Associate providers with networks and automatically cascade affiliations to connected entities.
  • Rapid Data Migration
    Ensure near term ROI and meet your deadlines with Rapid Data Migration.

Claims Configuration Enablement

Automate the Last Mile: From Provider Data to Auto Claims Configuration

Convert validated provider data—demographics, contracts, and fee schedules—into structured outputs that feed core admin and claims systems, reducing errors and accelerating processing.

  • Unified Provider Data Mapping
    Bring together provider demographics, contract details, and rates to create a complete configuration-ready dataset.
  • Claims-Ready Output Generation
    Translate complex provider data into formats consumable by claims system to improve reimbursement accuracy and SLA adherence.
  • Reduced Manual Intervention
    Eliminate manual intervention by enabling automated configuration based on governed business rules and pre-validated inputs.

Seamless Integration and Deployment

Deploy Provider1™ Without Disrupting Existing Systems

Implement Provider1™ rapidly with prebuilt connectors, modular APIs, and low-code tools, ensuring seamless integration across existing systems.

  • Prebuilt Connectors
    Integrate with Facets®, QNXT™, NASCO, and HealthEdge to maintain data consistency.
  • API and ETL Support
    Enable batch, streaming, and real-time data transfers to prevent data loss and version drift.
  • Self-Service Admin Tools
    Empower non-technical teams to configure workflows, update data, and manage credentialing processes independently.
  • Scalable Architecture
    Deploy Provider1™ as a standalone solution or integrate with existing systems to expand functionality without disrupting workflows.

Provider Lifecycle Managment is Complex.
Provider1™ Simplifies This for Everyone.

Automate, standardize, and accelerate provider workflows across intake, credentialing, contracting, and configuration—at scale.

Network and Provider Operations

  • Automate roster intake and validation to reduce manual efforts
  • Improve data quality up to 40%  
  • Reduce data management efforts by over 60%  

Contracting Teams

  • Digitize contract lifecycle with templates, redlining, and e-signatures
  • Manage fees and rates for contracts and auto loading to claims systems
  • Enable faster contracting while enforcing policies and procedures

Credentialing Teams

  • Streamline PSV with AI enabled automation
  • Maintain NCQA compliance
  • Auto-trigger recredentialing and monitor sanctions continuously

Finance and Business Operations

  • Reduce reimbursement errors and provider overpayments
  • Eliminate manual rework in reimbursement and fee calculations
  • Capture operational savings through standardization and automation

IT and Integration Teams

  • Deploy with modular APIs and flexible ETL support
  • Enable real-time, batch, and streaming data flows
  • Reduce IT dependency with business-friendly configuration tools

Member and Provider Experience Teams

  • More accurate provider directories = reduced member abrasion
  • More accurate reimbursements and directories = reduced provider abrasion
  • Enhance trust, satisfaction, and retention through reliable network data

Leading Plans Are Already Transforming Provider Operations. See How.

Top payers are automating end-to-end provider lifecycle management by eliminating manual efforts, disconnected systems, lack of guardrails, and error-prone claims configuration—using Provider1™. Discover how they’re accelerating onboarding, improving accuracy, and ensuring compliance with one powerful platform.

Leading Plans Are Already Transforming Provider Operations. See How.

Top payers are automating end-to-end provider lifecycle management by eliminating manual efforts, disconnected systems, lack of guardrails, and error-prone claims configuration—using Provider1™. Discover how they’re accelerating onboarding, improving accuracy, and ensuring compliance with one powerful platform.

Ready to Rethink Provider Operations?

Provider1™ is helping leading health plans improve network adequacy, digitize contracts, streamline credentialing, automate roster files intake, improve data management effectiveness, and configure claims-ready provider data—every time, everywhere. Discover how you can reduce effort, improve outcomes, and accelerate provider onboarding at scale.
See it in action

Experience the Power of a Connected Ecosystem

Provider1™ is part of the Simplify Health Cloud™. Seamlessly integrate with Simplify Healthcare’s full suite of intelligent solutions—spanning benefits, claims, service, and app development—to ensure accuracy, efficiency, and compliance across your product, benefits, and provider lifecycle.

Simplify Product and Benefits Lifecycle

Accelerate health plan operations across all lines of business with AI-powered sales enablement, configurable plan design, automated filings, and CMS-compliant document generation.

Explore Benefits1™ →

Simplify Claims Configuration

Configure benefits and provider data directly into claims systems like TriZetto® Facets® and QNXT™ using intelligent automation.

Explore Claims1™ →

Simplify Benefits Inquiry Experience

Deliver accurate, consistent benefits information across all channels—powered by AI-enhanced guidance that improves member experience and boosts NPS.

Explore Xperience1™→

Simplify Document Management

Auto-generate 150+ mandated and marketing documents with built-in 508-compliance, translations, and integrated print fulfillment.

Explore Simplify Docs™ →

Simplify Custom App Development

Design and deploy custom apps faster with embedded AI and low-code development—tailored to your organization’s unique needs.

Explore SimplifyX™ →

We don’t just deliver software—we work alongside your teams to guide implementations, simplify adoption, and ensure sustained success.

Explore HealthConsult

Frequently Asked Questions (FAQs)

What Payers Need to Know Before Elevating Provider Operations with Provider1™

How does Provider1™ maintain data accuracy?

Provider1™ is initialized with a scrubbed dataset during the rapid data migration process.  Guardrails are in place to support ongoing data cleaning during maintenance and file loading, such as roster files or any data files.  This approach elevates and maintains data quality over time. 

Can it handle both delegated and in-house credentialing?

Yes. Provider1™ supports both in-house and delegated credentialing models, with configurable workflows to track PSV, license renewals, and sanctions while maintaining audit-ready records.  Delegated providers are typically loaded and flagged as such so they do not trigger the in-house credentialing activities.

Does it integrate with our existing systems?

Absolutely. Provider1™ integrates seamlessly with core systems like TriZetto® Facets® and QNXT™, NASCO, and HealthEdge.  Provider1™ has also integrated with CVOs, directories, and portals.  Our integrations via Restful APIs or files ensure consistent data flow to any required downstream systems. 

How does it reduce credentialing cycle times?

Provider1™ accelerates credentialing by automating PSV tracking, license verification, and sanctions monitoring, reducing manual steps, minimizing delays, and addressing the increasingly common Captcha verifications.

Can it prevent contract discrepancies?

Yes. Provider1™ prevents contract and amendment discrepancies by enforcing the use of templates for contract types, while allowing variable driven language alternatives, all from a library of approved text.  Fees and Rates can be validated using business rules and bulk update functions to ensure consistency and accuracy

How is data integrity maintained over time?

Provider1™ has built in workflows, business rules, edits, and validations that enforce data standards to preserve quality during the constant maintenance of provider data.

How long does deployment take?

Provider1™ implementations typically take 6-8 months.  This can be on the shorter side for standard implementations with less complex data migrations, and on the longer side for implementations that require configuration to a customer’s specific need and data migration effort to manage incoming data quality and complexity.

Can non-technical teams manage workflows and data updates with Provider1™?

Yes. With self-service tools, business users can adjust workflows, update data attributes, and manage their changing business needs without needing to contact IT or Simplify Healthcare.