Provider data are the foundation of healthcare operations, but, for health plans, managing those data is a major pain point.
Inaccurate provider directories, credentialing delays and disjointed systems are common headaches across the healthcare industry. Inefficient management of provider data can driver higher costs and delays in care, causing more friction for patients and burnout for providers.
Startup Certify is building a modern data infrastructure that unifies provider data across sources and systems. The company aims to provide a single source of truth for provider data, company executives said.
Certify banked a $40 million series B funding round led by Transformation Capital, with continued backing from General Catalyst and Upfront Ventures and new support from SemperVirens. The startup has raised $69 million in total funding.
The company plans to use the funding to accelerate product, engineering and go-to-market efforts.
"Right now, we’re investing deeply in our platform. We just hired our first Head of AI to help us move even faster in applying machine learning to clean, connect, and verify provider data and push the boundaries of what is possible to automate in provider data. We’re also expanding our product suite and we’ll be announcing new capabilities soon that move us even closer to our vision," Anshul Rathi, founder and CEO of Certify, told Fierce Healthcare.
Certify serves health plans and digital health companies with end-to-end provider data needs, including credentialing, licensing, monitoring, and roster management. Certify's platform unifies provider data from thousands of primary sources—like state boards, certifying bodies and national clearinghouses—through automated pipelines and partnerships. It layers in self-reported data from providers and uses artificial intelligence and machine learning to attribute every data point to a unique provider record. The platform cleans, standardizes and normalizes the data.
"Provider data is the invisible backbone of healthcare, and right now, it’s broken. Providers are asked to fill out the same 40-page application over and over again across disconnected systems. And health plans have their own siloed databases. What should be a shared foundation has become the root cause of billions in administrative waste, delays in care, and provider burnout," Rathi said.
"This problem has persisted because the industry has treated it as an operations issue, solved through patchwork processes or point solutions that digitize outdated workflows. At Certify, we took a different approach. We’re not applying tech to a broken system; we’re rebuilding the system entirely," he said.
Certify says it's tripled its growth year over year as clients report strong results: 40% reduction in administrative costs, 30% improvement in provider data accuracy and 99.8% field-level accuracy. The company says its technology cuts provider onboarding time from months to days.
The startup initially entered the market in 2021 as a credentialing platform and then built out technology for end-to-end provider data needs.
"Credentialing was always a strategic wedge. It’s the first moment a provider enters the network, and that made it the perfect place to begin fixing the system from the inside out," Rathi said. "But our vision was never to stop there. Every department across a health plan relies on provider data, yet they’ve all been working off disconnected systems. The market is now waking up to the need for a unified, intelligent foundation, and we’re building the infrastructure that connects it all."
The company hosted a provider data summit event a few weeks ago, and health plan executives signaled a strong interest in collaborating for the benefit of providers, patients and plan operations toward a unified data layer, Rathi attests.
"This is new and it’s exciting. We’re really gratified to be leading this shift," he said.
There are several trends driving the demand for better data accuracy and provider access.
"There’s no question the regulatory bar is rising. Between the No Surprises Act and new NCQA (National Committee for Quality Assurance) credentialing standards taking effect in just a few days, on July 1, health plans are under more pressure to keep provider data accurate, timely, and accessible. Under the new NCQA guidelines, for example, plans are expected to track license expirations monthly and complete credentialing verifications faster than ever before," Rathi said.
The timing is perfect for Certify's technology to be in the market, he noted.
The company's platform continuously pulls from more than thousands of primary sources, flags upcoming license expirations before they become a problem and delivers clean, validated, directory-ready data, he noted.
"We don’t know exactly what future regulations will look like, but we do know this: The industry is moving toward greater accuracy, faster data exchange and stronger accountability. That’s why we’re not just solving for individual use cases—we’re architecting our nation’s modern provider data infrastructure, combining best-in-class technology, best-in-class data, and deep domain expertise to support whatever comes next," he said.
Certify integrates AI and machine learning into provider data management. "AI works best when paired with human expertise, strong governance and a deep understanding of the problem. Today, we use AI to resolve provider identities across fragmented data, extract fields from documents, and generate credentialing summaries. These tools help us operate at scale while delivering accurate, trusted results," Rathi said.
While there is palpable excitement about AI in healthcare, Rathi sees the real opportunity in building the infrastructure.
"AI is only as good as the data it’s built on, and much of healthcare data is still siloed, unstructured, and incomplete. The most transformative AI companies won’t just build models; they’ll build the middleware that powers data cleanup, integration, and governance. That’s exactly what we’re building at Certify," he asserts.
Using technology and AI to improve provider data accuracy doesn't just benefit health plans and digital health companies, Rathi contends. It helps remove friction for patients and clinicians.
A better system means providers could enter their information just one time, and those data stay with them, "verified, updated, and accessible wherever it’s needed," he said.
"It means less administrative burden for providers, faster onboarding into networks, and more time to focus on care. And for patients, it means more accurate directories, fewer dead ends when trying to find a doctor, and a healthcare system that feels more transparent and trustworthy. In many ways, data is the currency of trust—and when provider data is wrong, that trust breaks down," he said.
"Certify's health plan market penetration and powerful network effects set it apart in the healthcare data infrastructure space," said Scott Rosen, partner at Transformation Capital, in a statement. "Their team is modernizing provider data administration by rearchitecting the foundational layer that healthcare runs on. The opportunity ahead, to unify, simplify, and scale provider operations across the industry, is massive."