Health plans are operating across disconnected systems, manual rosters, stale directories, invisible network gaps, and unreadable contracts. Each one creates risk. Together, they're costing more than you know.
Purpose-built for health plans. Each solution targets a specific layer of provider data operations and each works standalone or as part of a unified platform.
Measured across production deployments with health plans across 30+ markets. Not benchmarks, real outcomes
Provider directory accuracy rate achieved post-deployment
Reduction in manual operations time across provider data teams
Contract term retrieval accuracy via IQT across all contract types
Automation in pricing configuration and Agreement ID assignment
Legacy tools were built to store data. MCheck® Provider is built to understand, act on, and continuously improve it
| Capability | Legacy Vendors | MCheck® Provider |
|---|---|---|
Roster Processing | Manual ingestion, template-dependent, days to complete | Any format, touchless automation, processes in minutes |
Directory Accuracy | Periodic batch updates, 15–30% error rates common | Continuous monitoring, 99%+ accuracy, ghost provider detection |
Network Adequacy | Annual snapshots, reactive to audit findings | Real-time gap detection, proactive adequacy alerts |
Contract Intelligence | Static PDFs, manual review, weeks to configure pricing | Natural language Q&A, 80%+ pricing automation |
Downstream Integration | Manual re-entry into FACETS/QNXT, error-prone | Direct validated data pushes to adjudication systems |
Compliance & Audit Readiness | 3-4 separate vendors, siloed data, integration cost | Continuous CMS/NCQA monitoring, audit-ready output always on |
Vendor Overhead | Annual snapshots, reactive to audit findings | One platform, shared data foundation, single relationship |
MCheck® Provider surfaces the right intelligence for every stakeholder — from front-line operations to the executive team managing STAR ratings
Fix pipeline issues & reduce manual work
Manage provider performance & coverage
Prevent overpayments, fix billing issues
Ensure regulatory compliance & audits
Get clean data for reporting & insights
A regional Medicare Advantage health plan used MCheck® Provider to unify disconnected systems across roster management, directory accuracy, and contract configuration — eliminating audit risk and reclaiming 60% of their operations team's time
MCheck® Directory Accuracy continuously monitored 300+ authoritative sources, eliminating ghost providers and stale listings before they triggered compliance exposure — achieving 99%+ accuracy across all service areas.
MCheck® Roster Automation ingested provider files in any format with no analyst intervention — processing thousands of records in minutes and eliminating the manual bottlenecks that had caused downstream claims errors.
ContractsAI extracted reimbursement terms and configured Agreement IDs automatically — cutting a 90-day pricing backlog to minutes and ensuring claims adjudication accuracy across FACETS.
No rip-and-replace. MCheck® Provider integrates with your existing systems and goes live without disrupting current workflows
Automatically aggregate provider data from multiple systems, formats, and sources, rosters, contracts, EMR feeds, CMS files — into one unified platform. No templates required.
Score and verify every provider record against 300+ authoritative sources — NPI Registry, CAQH, DEA, state boards. Enrich 80+ attributes and flag discrepancies before they reach downstream systems.
Continuously monitor provider data for changes that impact compliance, network adequacy, or member access. Surface ghost providers, license lapses, and adequacy gaps before CMS finds them.
Push validated, enriched provider data directly into FACETS, QNXT, member portals, and analytics systems — with no manual re-entry and a full audit trail on every change.
MCheck® Provider is purpose-built for health plan data environments. HIPAA-compliant infrastructure, HITRUST- certified operations, and SOC 2 Type II audited security, so your compliance team signs off without hesitation.
Access best practices, research, and trends designed for health plans managing complex provider data environments
