Know Your Provider (KYP) is enabling several State Medicaid programs to drive transformational change in healthcare provider enrollment and validation.
Industry's First Smart & Modular Provider Network Management System

Know Your Provider (KYP) is transforming the digital experiences of both Providers and State Enrollment Analysts (at either side of Medicaid program) into disruptive conversational engagements that culminated in massive cost-savings of USD $ 100 million annually for one of the largest State Medicaid programs.

Delivered by Social Enterprise Technology, KYP features an Intelli-Buddy “Lucy” that guides the user (both the Analyst and Provider) at each stage of the process. KYP uses latest pragmatic innovations to simplify, streamline and continuously optimize the entire life-cycle of enrollment process. It helps Providers struggling with complex application forms by enabling them to have a conversation with form. KYP enables intelligent automation, including provider-data verification, application review, external verification, risk-based decision analytics and account management, coupled with seamless addition from analyst findings (anywhere in the enrollment workflow) thus shrinking enrollment processing cycles from months to days. By digitising 80% of manual activities and by using advanced entity-resolution techniques to verify information against more than 15,000 sources, KYP stands true to its caption, World’s first smart and modular provider network management system. With a dashboard that shows an aggregated provider risk score with 360-degree view of provider including history, qualifications, affiliations, and news across time and geography, it assists enrollment analysts to make informed decisions.

Major Modules of

  • Portal
  • Enrollment
  • Screening
  • Monitoring

Delivered using Social Form, KYP offers a first of its kind intuitive and intelligent portal for the Providers struggling with complex application forms. The portal talks to Providers and assists them in filling out forms without them having to understand the State specific policies and requirements. Acting as their digital assistant it dynamically changes the flow of the application based on the provider's context asking the right information and documents applicable to each specific provider. Providers can thus smoothly complete their applications without the need for prior understanding of State specific requirements and policies. The Portal allows the providers to complete an application package in any order and across multiple sessions. Even better, multiple users can work on an application together across desktops and smart phones, chat together & even interact with enrollment analysts throughout the enrollment process.

Delivered using Social Case, KYP Enrollment transforms the life of Medicaid Enrollment analysts by enabling complete and intelligent automation of provider data verification process. KYP is the only solution enabling end-to-end automation including application review, external verification, risk-based decision analytics and account management; thus reducing the unnecessary returns and shrinking the enrollment processing cycles from months to days.

Delivered using Social Analytics, KYP Screening makes provider screening a completely “paperless” exercise and automates at least 80% of the activities which are done manually today. KYP uses complex entity resolution techniques to verify enrollment information against more than 15,000 best of breed data sources. KYP computes an aggregated provider risk score and an unprecedented 360 degree view of provider including history, qualifications, affiliations, adverse actions and negative news across time and geography And all of this information is made available to Medicaid analysts using an intuitive dashboard to form quick and constructive opinion about the providers.

Delivered using Watch List Management, KYP’s Monitoring module completely automates the monthly monitoring requirements for providers. Not only does it automate the mandatory checks against exclusion lists and licensed boards, it provides optional checks against federal, state and local criminal records. KYP provides comprehensive research and investigation tools within a digital workflow to triage and generate the alerts and to adaptively learn from false positives to increase the accuracy of future alerts. Gives complete control on managing provider applications.
Increases efficiency of users through digitization and automation
Reduces process cycle times and enhances adherence to SLAs
Improves customer service through superior interaction and collaboration

Some of its

It talks

With the worlds' first talking portal, the application talks to providers, assists them in form filling and packaging and guides them throughout the life-cycle of enrollment. It binds information, documents and stakeholders together.

It guides

Guides analysts in understanding end-to-end provider background. The application provides a comprehensive 360 degree view of providers and their affiliations. Also offers a comprehensive risk score on providers.

Gives comprehensive workflow history

It gives the enrollment analysts with detailed and intuitive view of the case workflow and milestones such as the comments and findings added by other analysts, queries raised by supervisors and attachments related to the case across the workflow.

Screens providers against 15,000+ data sources

KYP adds intelligence to provider disclosed information. Apart from the Medicaid mandated checks, KYP seamlessly screens the providers and its affiliates against several different sources to give an expert insight to the enrollment analyst

Provides a risk score based assessment

KYP adds intelligent risk scores to provider applications based on several identified traits. KYP also enables the enrollment analysts to modify these scores and add their findings. KYP also provides risk radial plot for the analysts to understand the distribution of risks for the given case.

Assists analysts in making informed desicions

KYP adds intelligence, provides an intuitive social dashboard, offers 360 degree view, suggests next best possible steps on the case and assists analysts in making informed provider enrollment decisions

Maintains provider accounts

KYP creates and maintains the account for all the approved cases. KYP enables the analysts to investigate the accounts and offers proactive analytics to make modifications to their status at any given timeframe


  • Electronic forms Classifies form into logical sections, eliminates repetition, and provides progress indicators at various levels
  • Guided preparation Built-in questionnaires to guide providers to the right forms supported by proactive help
  • Context-based intelligence Supports data auto-fill, validates data contextually and provides profiles and resource library for data reuse.
  • Social collaboration Supports secure message exchange with Enrollment departments, and application sharing with related user accounts
  • Account management Allows providers to view and manage account data including updates, re-enrollments, affiliations
  • Security Completely secures provider data and documents, supports multi-factor authentication, and uses e-signatures to control form submission
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