Credentialing remains one of the most regulated and labor-intensive processes in healthcare. Every stakeholder has a vested interest in doing it right:
- Health plans must meet NCQA, CMS, and state-mandated turnaround and monitoring standards.
- Providers want to join networks quickly and start seeing patients.
- And delegated entities or CVOs need to deliver credentialing decisions that are fast, accurate, and auditable.
Sutherland partners with health plans, delegated networks, and health systems to transform credentialing and recredentialing operations – combining AI-driven automation, integrated workflows, managed services, and upstream/downstream data optimization.
“The goals of credentialing – protecting patients, ensuring network quality, and meeting compliance standards – have never changed,” says Kymberly Eide, VP of Payer Solutions at Sutherland. “What’s changing is how we achieve them – with intelligent automation, shared models, and a connected data ecosystem that drives measurable outcomes.”
Automation and Intelligence Drive Measurable Efficiency
If you walked into a credentialing operation a decade ago, you might have seen spreadsheets, faxed verifications, and paper files. Today, Sutherland helps organizations reimagine this core process using automation, AI, and purpose-built workflows – bringing new levels of efficiency and transparency to credentialing.
Our clients share four common goals:
- Accelerate speed-to-decision: Reduce turnaround time from weeks to days through automation of verifications, data matching, and committee packet generation.
- Reduce administrative burden: Eliminate redundant tasks and manual data entry with intelligent workflows and robotic process automation (RPA).
- Ensure continuous compliance: Automate sanction, exclusion, and license monitoring aligned to NCQA and CMS requirements.
- Optimize upstream and downstream data flow: Create two-way integration between credentialing, provider data management, contracting, and directory systems for consistent, high-quality data across the enterprise.
“With automation and AI, we can remove 40–60% of manual steps in credentialing and recredentialing,” says Eide. “That’s not just efficiency – it’s risk reduction, better experience, and operational resilience.”
End-to-End and Multi-Payer Shared Credentialing Transformation
Sutherland offers the best insurance credentialing services with flexible operating models that allow health plans to modernize credentialing on their own terms – individually or collaboratively through its Multi-Payer Shared Credentialing Model.
- SmartCred® CVO and BPaaS Model: An NCQA-aligned, automation-enabled CVO service that manages PSV, credentialing, and recredentialing at scale.
- SmartCred® Multi-Payer Shared Credentialing Model: A collaborative framework allowing multiple payers to share verified provider data and recredentialing events – reducing duplication, cost, and provider abrasion while improving compliance and turnaround.
- AI-Enabled Workflow Platform: Prebuilt workflows for application intake, primary source verification, committee preparation, and provider notification.
- Continuous Monitoring and Reverification: Ongoing checks for sanctions, exclusions, and license status changes across all state and federal sources.
Each model can be tailored to meet the client’s maturity level – whether fully outsourced, hybrid, or internally managed with Sutherland’s automation and analytics layers.
Compliance, Quality, and Confidence
NCQA and CMS updates continue to raise expectations for digital verification, ongoing monitoring, and timeliness. Sutherland’s automation platform and credentialing workflows are aligned to these standards, enabling:
- Consistent, auditable credentialing decisions that meet NCQA and CMS FFE requirements.
- Improved readiness for accreditation audits through traceable automation logs and document workflows.
- Streamlined oversight of delegated entities with shared dashboards and standardized credentialing KPIs.
- Cross-payer transparency through Sutherland’s shared credentialing framework, improving data quality and regulatory alignment across plans.
“Our technology and services are built to keep clients compliant while future-proofing their operations for what’s next,” adds Eide. “We help them adapt as NCQA, CMS, and state requirements evolve.”
Preparing Clients for the Future of Credentialing
Sutherland works closely with payer, provider, and regulatory stakeholders to ensure clients stay ahead of change. We help health plans and delegated entities:
- Interpret and operationalize NCQA 2025 updates for digital verification and monitoring.
- Transition from manual or legacy systems to AI-driven credentialing and monitoring.
- Adopt the Multi-Payer Shared Credentialing Model to minimize redundant recredentialing and streamline compliance across payers.
- Build data pipelines that enhance downstream directory accuracy and upstream contracting workflows.
“We see credentialing not as an isolated function,” says Eide, “but as the foundation of provider data quality, network adequacy, compliance, and access.”
The Next Step is Yours
Discover how Sutherland SmartCred® platform, Multi-Payer Shared Credentialing Model, and BPaaS services can help you modernize credentialing, reduce administrative burden, and accelerate compliance. Contact Sutherland today!
