Top 7 Healthcare Provider Network Management Solutions You Need to Know

Managing provider networks today is such a complex responsibility. The process involves multiple, interconnected tasks, such as verifying qualifications, managing renewals, enrolling with various payers, monitoring ongoing compliance, and maintaining accurate provider data across systems. Yet, many teams still rely on spreadsheets, email threads, and manual checklists to track these processes, which increases the risk of errors, delays, and inefficiency. 

A single oversight, such as an expired license or a missing payer contract, can lead to denied claims, revenue loss, and even compliance penalties. To mitigate these risks, modern, technology-driven provider network management platforms were created. 

These platforms help you automate repetitive tasks, centralize provider data, and offer real-time compliance monitoring, which can help you operate more efficiently, reduce administrative burden, and focus more resources on patient care, saving you time and making your work more productive.

In this blog, we’ll walk you through the top seven provider network management platforms in the industry so that you can find the right fit for your organization’s needs and priorities.

Let’s get right in, but first, let’s talk about what provider network management is.

What is provider network management?

Provider Network Management (PNM) is the process healthcare organizations use to build, maintain, and optimize their network of healthcare providers, such as physicians, specialists, hospitals, and clinics. 

In simple terms, the process ensures that the right providers are available to deliver quality care, meet regulatory standards, and support the organization’s strategic and financial goals.

The primary purpose of provider network management is divided into two:

1. Quality of care

Ensuring patients have access to qualified, credentialed providers who meet clinical and ethical standards.

2. Operational efficiency

Streamlining administrative processes so providers can be onboarded, managed, and supported without unnecessary delays or costs.

These two primary purposes consist of multiple key components, such as:

• Provider recruitment: Identifying and attracting qualified healthcare professionals to fill gaps in the network and meet patient demand
• Credentialing: Verifying a provider’s qualifications, licenses, and professional history to ensure compliance with healthcare regulations and payer requirements
• Contracting: Establishing agreements with providers that define payment terms, responsibilities, and service expectations
• Data management: Maintaining accurate, up-to-date provider records to support decision-making and reporting
• Directory accuracy: Ensuring provider directories are current, accessible, and compliant with regulatory standards, which directly affects patient access and trust
• Compliance tracking: Monitoring licensure, certifications, and regulatory requirements to avoid penalties and maintain payer relationships
• Performance monitoring: Evaluating provider performance using quality, utilization, and patient satisfaction metrics to identify areas for improvement

Let’s now take a look at some of the top provider network management solutions you need to know.

7 best provider network management solutions

1. Assured (The best provider network management platform)

Assured is an AI-powered provider network management platform designed specifically for healthcare organizations. It automates critical administrative workflows—such as credentialing, licensing, payer enrollment, and ongoing compliance monitoring—so providers can onboard quickly, stay compliant, and reduce manual work. 

Built for scalability, Assured helps streamline operations across states and payers, reducing the time and cost associated with provider management, credentialing, licensing, and enrollment.

Let’s take a look at some of its key solutions.

Licensing

Licensing is the process of obtaining and maintaining the official state and federal authorizations a provider needs to practice. This can include state medical licenses, DEA registration for prescribing controlled substances, and specialty licenses. Without the right licenses, a provider cannot legally deliver care.

Assured automates and centralizes this process to keep providers compliant and ready to work.

Key Features

• Multi-State Licensing: Handles initial applications and renewals in all 50 states, helping telehealth and multi-location providers expand without jurisdiction delays
• Automated Renewals: Tracks expiration dates and automatically generates renewal applications, reducing the risk of lapses that can halt provider schedules
• High Success Rates: Proven track record of application approvals, meaning fewer rejections and less rework for your admin team
• DEA and CSR Support: Assists with obtaining and renewing DEA registrations and state-specific Controlled Substance Registrations
• Centralized Document Management: Stores all licensing documents in one secure location for easy retrieval during audits
• Interstate Compact Licenses: Facilitates faster licensing under agreements like the Interstate Medical Licensure Compact, cutting application time by up to 50%
• FCVS Setup and Management: Manages Federation Credentials Verification Service profiles for providers, speeding up verification by up to 30%
• Responsive Customer Support: Live, 24-hour knowledgeable support to resolve licensing issues quickly
• Broad Professional Coverage: Supports physicians, NPs, PAs, nurses, and other licensed healthcare professionals

Credentialing

Credentialing is the process of verifying a healthcare provider’s qualifications before they can practice in a facility or join a network. 

It involves checking education, training, licenses, board certifications, work history, malpractice coverage, and any disciplinary actions. The goal is to confirm the provider is competent, compliant, and safe to deliver care.

Assured speeds up this process with automation, real-time tracking, and NCQA-certified processes.

Key Features

• Automated Primary Source Verification (PSV): Pulls data directly from primary sources such as AMA, NPDB, OIG, and state licensing boards, reducing manual verification time from weeks to hours
• NCQA-Certified Compliance: Meets the highest national standards for credentialing accuracy and reliability, critical for payer and regulatory approval
• Scalable Credentialing Processes: Handles large volumes of providers without slowing down, ideal for growing health systems and telehealth companies
• Real-Time Status Tracking: Gives administrators and providers complete visibility into application progress at any time
• Cost and Time Efficiency: Cuts credentialing time by up to 80%, helping providers start seeing patients (and generating revenue) sooner

Payer enrollment

Payer enrollment is the process of registering a provider with insurance companies such as Medicare, Medicaid, and commercial plans. This is done to enable them to bill for services and receive reimbursement. 

Even if a provider is credentialed, they can’t get paid by a payer until they’re officially enrolled and assigned the necessary billing IDs.

Assured makes this complex process far more manageable.

Key features

• Comprehensive payer coverage: Works with Medicare, Medicaid, and hundreds of commercial payers nationwide
• Automated tracking and monitoring: Follows each enrollment application through every stage, flagging missing documents or stalled approvals
• Streamlined provider roster management: Maintains accurate, up-to-date rosters for each payer, ensuring compliance with contract requirements
• CAQH profile management: Creates and maintains provider profiles, ensuring they’re complete and attested every 120 days
• PECOS integration: Directly integrates with Medicare’s PECOS system for faster submissions and fewer errors
• NPI registry synchronization: Keeps provider identifiers consistent and accurate across all payer systems

Network management

Network management refers to the ongoing oversight of all providers in a healthcare organization’s network. This includes keeping provider rosters accurate, tracking compliance requirements, monitoring licenses and credentials, and ensuring the network meets payer and regulatory standards at all times.

With Assured, you can keep your network audit-ready at all times.

Key features

• Continuous monitoring: Tracks provider statuses in real time, including license expirations, sanctions, and disciplinary actions
• Real-time compliance alerts: Notifies teams immediately of any issues that could impact billing or compliance
• Centralized provider rosters: Maintains a single source of truth for all provider data across locations and payers
• Comprehensive audits: Generates detailed compliance and performance reports for internal reviews or external audits
• Secure document storage: Keeps all provider documentation encrypted and easily accessible for authorized staff

What makes Assured stand out

• Credentialing time drops from 60+ days to around 2 days
• Administrative burdens fall by 80% and provider onboarding becomes fast and predictable
• The platform continuously monitors over 2,000 verified data sources
• The platform flags issues early, streamlining average workflows significantly
• Implementation time is usually under 72 hours, and customers typically see ROI via faster billing, cleaner compliance, and reduced manual effort within the first month
• The platform is NCQA-certified as a Credentials Verification Organization (CVO)
• NCQA, Joint Commission, and CMS standards are integrated into workflows
• The platform’s API-first architecture connects smoothly with existing EMR, ATS, Salesforce, CAQH, NPPES, state boards, PECOS, and more, eliminating redundant data entry
• There is daily surveillance of provider status, immediate alerts, and centralized rosters that minimize risk exposure and keep providers audit-ready

Here’s a breakdown of the ROIs you can measure with Assured.

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2. Medallion

Medallion is a modern provider network management platform that combines credentialing, enrollment, licensing, and monitoring. It was designed to help healthcare teams onboard providers faster, stay audit-ready, and eliminate the challenges of using manual processes. 

Its AI-driven engine guarantees near-instant verifications and has even been shown to cut credentialing time by 60% in some cases.

List of solutions

• Provider data management: Centralizes all provider data (from licenses to CAQH profiles) in one place, automating updates and syncing data across your systems in real time. That means fewer errors, less manual chasing, and real clarity on where each provider stands
• Monitoring: Runs checks across sanctions, exclusions, and license expirations to keep your network clean, compliant, and audit-ready
• CVO credentialing: Combines software with NCQA-certified CVO (Credentials Verification Organization) services, delivering credentialing files that meet standards like NCQA, TJC, and CMS, with an accuracy of around 99.5% accuracy
• Privileging: Helps hospitals and credentialing teams assign, track, and manage provider privileges across facilities, without the paperwork
• Direct payer enrollments: Automates enrollment for providers, groups, and facilities, including follow-ups and alerts, helping reduce denials and speed up revenue collection
• Delegated payer enrollments: If your organization handles delegated credentialing, Medallion supports NCQA-compliant workflows and roster updates, automating the entire process
• Licensing: Medallion makes licensing across states seamless, from applications to renewals, including IMLC and NLC licenses, with visible tracking and audit-ready documentation

Key features

• Real-time sanctions & exclusion checks: Automatically runs continuous checks against OIG, SAM, and state-level exclusion lists, with instant alerts for compliance teams, reducing the risk of penalties or revenue clawbacks
• Centralized provider profiles: Eliminates duplicate records and keeps details synced across credentialing, enrollment, and HR systems
• Integrated licensing workflows: Supports initial license applications, renewals, and interstate compacts (IMLC, NLC), with status tracking and automated reminders for expirations
• CAQH integration & auto-attestation: Connects directly to CAQH, updates provider profiles, and auto-attests every 120 days, avoiding one of the most common payer enrollment delays
• Delegated credentialing support: For organizations with NCQA-approved delegated credentialing agreements, Medallion streamlines roster submissions and compliance reporting.

Pros

• Real-time dashboards, coverage tracking, and centralized records that make operations fast and transparent
• With certifications across NCQA, CMS, TJC, and SOC 2, Medallion is built for audit readiness
• Scalable and designed for growth 

Cons

• New or smaller teams might find Medallion’s depth overwhelming at first, especially without dedicated onboarding support
• Setup can be complex, customizing workflows, integrations, and user roles takes planning

3. OSP Labs (Optimal solutions provider)

OSP (Optimal Solutions Provider) is a healthcare technology company specializing in custom-built solutions that streamline provider network management for payers, providers, and healthcare organizations. Their platform focuses on eliminating redundant manual work, improving provider contracting processes, and ensuring faster, more accurate credentialing. 

OSP’s approach is highly customizable, meaning it can be tailored to the workflows, compliance requirements, and integration needs of any healthcare organization. 

List of solutions

• Automation of provider network management (PNM): Automates repetitive, manual tasks in provider contracting, credentialing, and compliance tracking

• Workflow management: Helps organizations map, monitor, and optimize every step of the provider lifecycle

• Data management: Centralizes provider information into a single, secure database, enabling teams to access accurate and up-to-date records instantly

• Relationship management: Streamlines communications between providers, payers, and internal teams, thereby fostering stronger collaboration, better onboarding experiences, and long-term provider retention

• Contracting management: Digitizes and automates provider contracting processes, ensuring quicker negotiations and minimizing delays in execution

• Credentialing: Speeds up the verification of provider qualifications, licenses, and certifications by integrating with primary source databases and ensuring compliance with NCQA and CMS standards

Key features

• AI-Powered process optimization: Uses AI and machine learning to detect anomalies, predict credentialing delays, and improve decision-making speed
• Role-based access control: Grants permissions based on user roles, improving security and safeguarding sensitive provider data
• Analytics & reporting dashboards: Offers detailed performance insights into credentialing timelines, network compliance health, and onboarding efficiency
• Scalable cloud infrastructure: Handles large-scale provider data with high performance and integrates seamlessly with existing healthcare IT systems

Pros

• Can be rolled out in modules or as a complete end-to-end network management platform
• Strong configurability to match unique payer needs
• Advanced workflows to improve operational efficiency and reduce FTE (Full-Time Equivalent) requirements

Cons

• Customization requires more development and testing before launch
• Tailored solutions may cost more upfront than off-the-shelf software
• Teams moving from manual processes may need training to adapt

4. Symplr provider

Symplr Provider is a cloud-based platform built to manage every stage of provider network operations, credentialing, privileging, payer enrollment, contracting, and directory management. 

The platform has helped payers credential 60% more providers, 30% faster, by leveraging automation.

List of solutions

• Symplr CVO: Offers expert-level support to clear credentialing or enrollment backlogs
• Symplr Payer: Provides a comprehensive workflow system for health plans and managed care that automates provider data from credentialing and contracting to network oversight and compliance tasks
• Symplr evidence analysis: Delivers real-world clinical insights and evidence-based research, helping leadership and clinical teams make data-driven decisions on standards, supplies, and procedures
• Symplr directory: Acts as your centralized hub for provider data, powering search, scheduling, and outreach across EHRs, public-facing platforms, and revenue cycle systems

Key features

• Workflow automation: Automates credentialing pipelines, contract workflows, and application routing with configurable logic
• Compliance & facility management: Supports regulatory workflows and tracks compliance status for facilities and provider access
• Verification & privileging tools: Manages privileged access and board reviews within a single system, with integrated committee review functionality
• Document handling & audit trails: Houses credentialing documents securely and tracks missing pieces, making audits smoother
• Master data governance: Provides a centralized "system of record" for provider data, with import/export capabilities and anomaly detection
• Critical compliance certifications: The platform is HITRUST CSF certified and recognized as a "Major Player" by IDC for its comprehensive provider data management capabilities

Pros

• Significantly cuts down manual tasks, speeding up provider onboarding and reducing administrative strain
• Maintains a single, clean source of provider data across the enterprise, improving accuracy for EHR, payer, and public-facing directories
• Helps meet NCQA, CMS, and state-level compliance requirements with built-in monitoring and reporting tools
• Keeps provider contact, specialty, and availability data updated and synchronized across systems

Cons

• New users often require extensive training to navigate the platform efficiently
• Full deployment and configuration can be lengthy, especially for large, complex organizations
• While highly configurable, some advanced customizations may require vendor support, adding cost and time
• Some users report that integration with older or custom-built EHR systems requires additional technical effort

5. HealthStream

HealthStream is a leading provider of healthcare-focused solutions, built to support credentialing, provider portfolio management, compliance training, and workforce development. 

The platform combines credentialing workflows with immersive learning, advanced analytics, and performance management.

List of solutions

Credentialing & provider network management

• CredentialStream: Accelerates credentialing, privileging, and enrollment through intelligent workflows, mobile collaboration, and HITRUST-certified infrastructure for faster time-to-revenue
• Network by HealthStream: Tailored for health plans, this solution automates payer credentialing, provider directory updates, network adequacy checks, and contract management, streamlining network operations
• HealthStream CVO: Offers NCQA-certified services that supplement your internal processes to scale capacity during high-volume or consultative needs
• Provider portfolio: A mobile credential wallet giving providers one-click access to share up-to-date credentials, syncing with other HealthStream tools and automated CME updates

Learning & performance

• Learning management system (LMS): A flexible and healthcare-tailored LMS that supports streamlined compliance, customizable learning paths, video training, and advanced analytics
• Performance & engagement tools: Includes tools like Performance Center for skill tracking and feedback, plus competency development modules for professional growth across clinical teams

Scheduling & capacity

• While primarily focused on provider network management, HealthStream also supports hospital capacity planning, which facilitates demand forecasting, optimizes nurse scheduling, and patient flow management using tools like Capacity Planner™, Enterprise Visibility®, and ANSOS™

Reimbursement & resuscitation training

• HealthStream offers medical education and certification tools, including BLS, ACLS, PALS, CPR/AED, obstetric ALS, and more, along with analytics to monitor training effectiveness and compliance

Key features

• Comprehensive content library: Access thousands of ready-made, healthcare-specific courses, templates, and assessments for training, credentialing, and performance management
• Customizable learning paths: Create tailored education roadmaps that align with each role and competency requirement
• Advanced reporting & analytics: Track credentialing timelines, learning outcomes, performance gaps, and network health with dashboards and benchmarks
• Integration capabilities: Seamlessly connects with systems like Epic™, HRIS, CAQH, and HealthStream’s broader hStream ecosystem via APIs
• User-friendly interface: HealthStream products are designed to be intuitive for providers and admin staff, improving adoption and engagement

Pros

• Users consistently praise HealthStream’s user-friendly design and how simple it is to navigate assignments and track progress
• HealthStream’s tracking mechanisms and email reminders keep both staff and managers aligned on required coursework and compliance milestones
• Provides quick support response times and helpful service, especially during audits or complex setups

Cons

• While capable, HealthStream's backend can feel overly complex. Creating content or running reports sometimes requires a learning curve or additional support
• Some users have experienced performance issues, slow loading, browser clashes, or glitches

6. CertifyOS

CertifyOS is a modern, API-first provider intelligence platform designed to simplify credentialing, licensing, enrollment, and network monitoring. 

It is built to replace slow, manual workflows, and it delivers real-time provider verification and network insights in a shorter timeframe.

List of solutions

• Credentialing: CertifyOS automates credentialing for any provider type using real-time primary-source integrations. It centralizes credentialing data, supports NCQA and CMS compliance, and empowers virtual committee review, all from a single dashboard
• Licensing: The platform streamlines licensing workflows across states with dynamic state-specific requirements, built-in fingerprinting and CME support, and real-time tracking, helping you avoid missed renewals and non-compliance risks
• Monitoring: CertifyOS continuously monitors sanctions, license expirations, and compliance status. Real-time alerts keep your team proactive, compliant, and audit-ready
• Payer enrollment: The platform has integrated credential data, speeding reimbursement turnaround and reducing administrative burden
• Roster management: With RosterOS, CertifyOS consolidates multiple provider rosters into a single source of truth. In just the first month post-implementation, many organizations see roster ingestion, validation, and consolidation happen in under 30 days

Key features

• Automated credentialing & real-time verification: Validates credentials instantly across boards, DEA, NPI, and more, reducing weeks of manual work into minutes
• Multi-state licensing & renewal automation: Offers prebuilt requirement sets and automated renewals to replace scattered paperwork with proactive management
• Continuous compliance monitoring: Alerts your team instantly when changes in provider status occur, minimizing risk and audit exposure
• Seamless enrollment workflows: Integrated with credentialing modules to fast-track access to payer networks with minimal administrative friction
• Unified provider data hub: Improves data accuracy and consistency across systems
• Real-time network insights: Gives your team visibility into provider distribution, network coverage gaps, and performance to support strategic planning
• API-first architecture: Easily integrates into any tech stack, with RESTful APIs, webhooks, and developer-friendly support

Pros

• Reduces provider onboarding costs by up to 40%
• NCQA-certified and SOC 2 Type 2 compliant for audit readiness
• API-first architecture integrates seamlessly into existing tech stacks
• Scales easily for fast-growing healthcare networks
• Delivers real-time compliance and network performance insights

Cons

• Transition can be challenging for teams reliant on legacy or paper-based systems
• Integration and training require upfront time and resources
• API-first design may require dedicated IT support for setup and maintenance
• The platform has a learning curve for teams new to automated credentialing platforms

7. Credsy

Credsy is a cloud-based platform focused on streamlining provider licensing, credentialing, monitoring, and payer enrollment. The platform helps organizations save around 93% of time compared to traditional workflows. 

It offers visibility and control throughout the provider lifecycle, ensuring compliance while supporting revenue growth.

List of solutions

• Payer enrollment: Credsy handles both commercial and government payer enrollment, including CAQH registration, NPI issuance, Medicare/Medicaid enrollment, PECOS submissions, and revalidation
• Licensing: The platform automates licensing across all 50 states, the U.S. territories, and the IMLC system. It supports DEA & CSR registrations and FCVS setup and management, with upfront applications and monitoring
• Privileging: Credsy includes privileging support, helping teams track, manage, and store privileging documentation to maintain compliance across facilities

Key features

• Automated renewal and monitoring: Credsy sends reminders up to 90 days before expiration, helping prevent credential lapses across licensing, CAQH, and other requirements
• Secure document storage: All provider documents (licenses, certifications, contracts) are securely stored in one centralized location, improving access and audit readiness
• Smart filters and search: Internal teams can quickly locate providers, credentials, or expiration dates using robust filtering and search tools, saving time on audits or renewals
• Free provider dashboard: Providers gain access to a dashboard where they can manage their credentials, track renewals, and store documents, which boosts transparency and self-service
• CME storage and tracking: The platform tracks Continuing Medical Education (CME) credits automatically, applying them across states and professions as needed. It also offers reminders to maintain compliance
• Automated primary source verification (PSV): Credsy’s PSV feature verifies provider credentials directly from licensing boards and governing bodies, improving speed, compliance, and data integrity

Pros

• Renewal reminders, monitoring, and PSV reduce manual follow-ups
• Secure storage for licenses, certifications, and contracts
• Improves transparency and reduces back-and-forth with providers
• Quickly locate credentials, dates, or providers during audits
• Integrated CME storage and alerts keep providers compliant

Cons

• Limited public documentation on EMR/EHR or payer system integrations
• No dedicated mobile app for providers or admins
• Advanced automation features may require initial training to maximize benefits

Factors to consider when choosing the right solution for your organization

With so many solutions available, it’s easy to be swayed by flashy features that don’t necessarily solve your challenges. That’s why it’s important to focus on specific, high-impact factors that directly influence efficiency, compliance, and provider satisfaction. Such factors include:

• Compliance and regulatory support: The platform should support requirements from CAQH, NCQA, CMS, and state-specific regulations, helping you stay audit-ready at all times
• Integration with existing systems: It should seamlessly connect with EHRs, claims systems, credentialing tools, and other core healthcare software
• Automation capabilities: Look for features that automate data entry, primary source verification, expiration reminders, and other repetitive tasks to free up staff for higher-value work
• Scalability: The solution should scale easily without losing speed or functionality
• Reporting and analytics: Look for comprehensive dashboards and data export options that help track performance, identify gaps, and make evidence-based decisions
• Provider engagement tools: Consider features like self-service portals, mobile access, and automated updates to keep providers engaged and reduce back-and-forth communication

Compare all 7 leading solutions side-by-side to make the best decision for your organization

Feature Comparison Matrix

Wrapping up

The right solution can help you maintain accurate provider data, minimize errors, and ensure your network meets both regulatory and contractual requirements. When evaluating tools, prioritize those that can scale with your organization, integrate seamlessly with your existing systems, and offer strong data accuracy features. 

If you’re unsure where to start, consider booking a demo with Assured or exploring free trials. This hands-on approach can help you see how the platform fits your workflows before committing to a full rollout.

Frequently asked questions

1. Why is Assured ranked #1 when other solutions have been around longer?

Assured earned the top spot because they solved the core problems that legacy platforms couldn't: speed and accuracy. While HealthStream and Symplr have longer track records, they're built on older architecture that requires manual processes. Assured's AI-powered platform achieves 2-day credentialing with 99.5% accuracy, while most established players still take 60+ days. Sometimes being newer means having better technology.

2. If I'm only managing 50-100 providers, do I really need these enterprise-level features?

Most platforms require you to hit 200+ providers to justify their complexity and cost. Assured is unique because they designed their platform to scale efficiently from 50 providers to 5,000+ without changing your workflows. While Credsy might seem cheaper initially, you'll outgrow it quickly. Assured's pricing scales with your growth, making it the only platform you'll never need to replace.

3. How do I know which of these 7 solutions will actually work for my specific situation?

Start with implementation speed and track record. Assured consistently delivers 72-hour implementations and shows real ROI within the first month, while Medallion and Symplr often take 3-6 months just to get running. The best approach is booking demos with your actual requirements and asking for customer references in similar-sized organizations. Assured's 98% customer retention rate suggests their demos accurately reflect real-world performance, unlike platforms that over-promise during sales.

4. Are the smaller/newer companies on this list risky compared to established players?

Assured actually reduces risk compared to legacy providers. They're NCQA-certified (same as the big players) but with modern, cloud-native architecture that's more reliable than older systems. While HealthStream has more years in business, Assured has faster support response times, better uptime, and transparent pricing. Plus, their customer retention rate is 98% vs the industry average of 78%.

5. What if I choose the wrong platform - how difficult is it to switch later?

This is exactly why Assured offers the most flexible onboarding in the industry. Unlike Symplr or OSP Labs that lock you into 3-year contracts with expensive change fees, Assured's month-to-month option lets you scale up confidently. Most clients stay because of results, not contract restrictions. They also offer free data migration if you're switching from another platform - something competitors charge $50K+ for.