Credentialing Agent

Never a lapsed license, expired doc, or missed re-cred deadline.

What it does

The Credentialing Agent owns the provider-credentialing role end-to-end. It builds a document checklist per provider, verifies NPI against the NPPES registry, screens continuously against the OIG-LEIE and SAM.gov exclusion lists, and tracks every expirable credential (license, DEA, board certification, malpractice COI) so a provider never silently goes non-billable. It assembles the primary-source-verification evidence, drafts payer/PECOS enrollment applications, and routes each one to a human for one-click approval before submission. It works on provider data (not patient charts), so it carries minimal PHI. Every verification and submission is fully audited. You always sign the final attestation — the agent does the paperwork, you make the call.

A provider credentialing & enrollment specialist: verifies every provider against primary sources, screens exclusion lists continuously, tracks every expiration, and drafts payer enrollment — with a human signing off before anything is submitted.

What it watches & does

NPI verification against the NPPES registry
Continuous OIG-LEIE + SAM.gov exclusion screening
Expiration tracking + proactive renewal for every credential
Primary-source-verification evidence assembly
Per-payer enrollment + re-credentialing task tracking
One-click human approval before any external submission
Full audit trail with provenance
Learns per-payer enrollment quirks over time

Things it catches

Provider on the OIG-LEIE exclusion list — flagged before they could bill a federal program
DEA registration expiring in 45 days — renewal auto-started, no gap in prescribing
NPI on file doesn't match the NPPES registry name — surfaced for correction
Malpractice COI lapses next month — reminder sent well ahead of the deadline
Re-credentialing due in 90 days across 6 payers — tasks opened automatically