Automated Provider Data Validation
We provide continuous monitoring and auditing for your provider rosters. You never have to worry about being outdated and have compliant, audit-ready provider data.
No worry
Accurate. Compliant. Partner-Friendly.
ProviderLenz transforms the manual, time-intensive process of provider data validation into a fully automated, auditable workflow. Health plans—especially Medicare Advantage and Medicaid plans—are required to regularly validate provider information to meet CMS oversight standards and No Surprises Act transparency requirements. By automating this process, ProviderLenz ensures provider records are current, complete, and accurate, while reducing the administrative burden on network partners.
Multi-layer
AI-Enabled Validation at Scale
ProviderLenz applies a multi-layer, AI-assisted validation workflow to check every provider record across key attributes, including:
- Licensure, credentials, and specialty
- Tax ID (TIN) and National Provider Identifier (NPI)
- Network participation and affiliations
- Locations, contact information, and availability
AI and machine learning detect discrepancies, identify missing data, and reconcile conflicting records—delivering more reliable results than manual outreach.
Law abiding
Compliance Built-In
1. Medicare Advantage
Supports quarterly outreach to the plan’s entire provider network, helping health plans meet CMS requirements for directory accuracy and oversight
2. No Surprises Act
Ensures that provider information used for cost transparency and patient access is accurate and fully auditable
3. Auditable Workflows
Full tracking of communications, validations, and updates, creating a defensible audit trail for regulators and internal governance
Why
Benefits for Health Plans and Network Partners
By automating provider data validation, health plans can confidently deliver accurate provider information to members, regulators and internal systems, while strengthening relationships with their network partners.
Reduces burden on providers
Automated outreach and validation eliminates repetitive manual requests, making the health plan easier to work with
Saves time and cost
Scalable automation reduces staff effort while improving data quality
Improves trust and compliance
Reliable, up-to-date provider data supports directories, claims, prior authorization, member portals, and regulatory reporting
Single Source of Truth
Integration Across Systems
Validated provider data flows directly into all downstream systems, including:
- Claims administration (Facets, QNXT)
- Online provider directories and member portals
- Contracting and credentialing modules
- Risk, quality, and analytics platforms
This ensures a single source of truth across all operational and member-facing systems, while maintaining auditability and regulatory compliance.
