How does Convergent ensure the accuracy and adequacy of provider data?

Convergent uses advanced AI-driven algorithms to automatically clean, validate, and enrich provider data, ensuring that your network is both accurate and adequate. Our solution continuously monitors data for errors and discrepancies, reducing manual intervention and ensuring compliance with regulatory standards.

Is Convergent compatible with health plans' existing systems and workflows?

Yes, Convergent is designed to integrate seamlessly with your current systems, including EHRs, claims processing systems, and provider directories. Our flexible APIs and interoperability features make it easy to incorporate Convergent into your existing workflows with minimal disruption.

What support and training are available for Convergent users?

We offer comprehensive customer support options and detailed documentation. Additionally, we provide training resources such as webinars, user guides, and personalized onboarding sessions to ensure your team is fully equipped to maximize the benefits of Convergent.

How does Convergent help with compliance and regulatory reporting?

Convergent is built to support compliance from the ground up. It includes native features that address CMS, ADA Section 508, and No Surprises Act requirements. With HL7 FHIR-native APIs, automated audit logs, and real-time data validation, Convergent helps ensure your provider data meets regulatory standards and is always inspection-ready—reducing risk and streamlining reporting workflows.

Convergent

Provider Data Management. Simplified.

Convergent is the AI-powered Operating System for health plans without massive IT budgets.

Automate the deduplication, matching, enrichment, and validation of provider data.
Seamlessly integrates with standalone apps for AI roster processing, APIs and exports, and provider search.
Modular ecosystem makes it affordable to get started and effortless to scale.

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Why Convergent?

Purpose-Built for Simplicity

Convergent is an AI-powered, provider data operating system that manages complex data processes simply and affordably.

Built-In Compliance

Convergent doesn't just help you collect data—we help you prove it’s correct, accessible, and up-to-date. You get automated compliance tracking, reporting tools, and built-in logic that flags risk before it becomes a penalty.

Native, embedded compliance support for:
- No Surprises Act (provider directory accuracy, coverage info)
- ADA/Section 508 (accessibility of provider search tools)
- CMS audit readiness (tracking changes, audit trails, date-stamped logs)

Efficiency Results:

73%

Time saved per employee per quarter

Real-Time Data Integrity Across All Systems

The core functionality of Convergent is the automated standardization, deduplication, and enrichment of provider data across systems to maintain a single, reliable source of truth. Real-time updates flow downstream to eliminate lags and silos.

Why it matters:
- Reduces CMS non-compliance penalties
- Eliminates duplicate or missing records
- Improves care coordination, referrals, and member search experience

Proven Data Enrichment Results:

99%

Average enrichment rate

Downstream Integration Without the Dev Headaches

Integrates quickly and reliably with EHRs, claims systems, and provider search tools. FHIR® 4.0.1 and proprietary APIs, real-time exports, and custom CSVs push data to any system. Easy to implement. No dev team required.

Modular Scalability

Deploy what you need now, and expand as requirements grow. Convergent’s flexible, modular platform includes add-ons for AI roster automation, provider directories, and APIs & exports.

True AI-Driven Automation

Large Language Models (LLMs) power roster ingestion, schema mapping, validation, and enrichment. Provides real-time confidence scores and gets smarter every time. Faster decision-making and reduced manual workloads for your team.

Roster Processing Results:

96%

Increase in roster ingestion speed

Core Use Cases

Find the right app or mix and match to deliver better service to members, maintain strong provider relationships, and ensure your data meets the highest standards of accuracy and compliance.

Provider Data Accuracy and Cleansing

Self-Service Provider Directory Management

Intelligent Provider Roster Automation

Compliance and Regulatory Automation (Regulatory Adapters)

Real-Time Provider Data Integration and Interoperability (Exports/APIs

Network Adequacy
Monitoring

Audit and Error
Reduction

National Provider Reference Data-as-a-Service APIs

Built-in Compliance Engines

Native support for No Surprises Act, ADA/Section 508, and CMS audit readiness built into the workflows. Automatically tracks, logs, and proves compliance.

direct-trust-accreditation-ehnac-standard-regulatory

section-508-compliant-standard-regulatory

Consolidated Appropriations Act, 2023 Amendments:

Providers must include essential information: names, specialties, addresses, and telephone numbers.
Cultural and linguistic capabilities (including languages offered) must be listed.
Availability for new Medicaid and CHIP patients should be indicated.
Accommodations for physical disabilities must be detailed.
Provider internet websites (if applicable) should be included.

CMS Interoperability and Patient Access Final Rule:

Provider directory API based on HL7 FHIR standards is required.
Regular updates (at least every 30 days) ensure accuracy.
Public access without authentication or authorization is essential.

CMS 2020 Medicaid Managed Care Final Rule (CMS-2408-F):

Directories must be accessible to individuals with disabilities (ADA and 508 compliant).
“Mobile-enabled” directories (responsive mobile websites or apps) are necessary.

No Surprises Act:

Prompt updates (within 2 business days) upon receiving provider information changes.
Verification and updates at least every 90 days.

The Improving Seniors’ Timely Access to Care Act:

Regular verification and updates (at least every 90 days).
Easily accessible directories for beneficiaries (both online and in print).

Pricing

A modular, app-based pricing model enables you to address your most pressing needs on any budget.

Annual pricing (save 20%)

Contact sales for enterprise licensing cost

Customer Stories

See what customers are accomplishing with Convergent.

Erin Liberti

VP of Provider Relations, CenterLight Healthcare PACE

“Integrating Convergent to create a unified source of truth has drastically reduced the resources spent on managing fragmented provider data, benefiting members, providers, and internal teams alike. Their expertise in healthcare operations, innovative solutions, and dedicated support have driven measurable improvements in our efficiency and performance.”

Craig Behm

President, CRISP Shared Services

"Ensuring the accuracy and reliability of provider data is critical to our mission of supporting health information exchange across multiple states. Our partnership with Leap Orbit has been instrumental in enabling CRISP Shared Services to clean, enrich, and push accurate provider data downstream to the services we provide clinical users, care coordinators and public health professionals."