Healthcare orgs run exclusion checks and provider credentialing as separate fragmented workflows across different teams and spreadsheets, creating gaps and duplicated effort.
A single platform that combines provider onboarding, credentialing verification, and exclusion screening into one workflow with role-based ownership, automated handoffs, and a shared audit trail.
Freemium — free for up to 100 providers with basic OIG checks; paid tiers ($300-$2,000/mo) for continuous monitoring, multi-list coverage, credentialing integration, and team collaboration features.
The pain is real and validated — fragmented spreadsheets, duplicated effort, trust erosion in internal processes. However, it's a 'slow bleed' pain, not an 'on fire' pain. The Reddit signals confirm frustration but also reveal that leadership won't spend until something goes wrong. This means sales cycles will be longer and often triggered by audit findings or incidents rather than proactive buying.
TAM is meaningful but niche. ~6,000 hospitals, ~30,000 large physician groups, and tens of thousands of smaller practices in the US need some form of credentialing and exclusion screening. Realistic serviceable market for this specific combined workflow tool is mid-market orgs (100-2,000 providers) — perhaps 5,000-10,000 potential accounts at $300-2,000/mo = $18M-$240M SAM. Not venture-scale without expansion, but solid for a bootstrapped SaaS.
This is the weakest link. The Reddit thread itself flags it: 'Leadership doesn't want to spend on new tools until something goes wrong.' Compliance tooling is a grudge purchase. The $300-2,000/mo range is reasonable IF you can get past the 'we've always used spreadsheets' objection. Freemium helps, but converting free users in healthcare compliance is historically slow. Budget holders are often not the daily users feeling the pain.
Core MVP is very buildable: OIG LEIE database is downloadable monthly, SAM has an API, basic workflow engine with role-based access is standard SaaS. No exotic tech needed. A solo dev with healthcare domain knowledge could ship a functional MVP in 6-8 weeks. The harder part is multi-state exclusion list coverage (50 states, inconsistent formats) — that's a data engineering grind but not a blocker for MVP.
This is the strongest signal. Existing tools are either screening-only (Verisys) or credentialing-only (Modio/Medallion) or manual (SAM/OIG). Nobody owns the combined workflow with role-based handoffs and shared audit trail for internal compliance teams. The gap is real and structural — incumbents are organized around payer needs, not provider-organization compliance team needs. The 'workflow glue' between screening and credentialing is genuinely unserved.
Excellent subscription fit. Exclusion screening must be done monthly (OIG guidance). Credentialing is ongoing with expirables, re-credentialing cycles, and new hires. Once an org's workflow runs through this platform, switching costs are high — audit trail, historical data, and team processes all live there. Natural expansion from basic OIG checks to continuous monitoring to full credentialing.
- +Clear, validated gap — nobody combines credentialing workflow + exclusion screening for provider organizations
- +Strong regulatory tailwind — CMS enforcement is increasing, making this progressively more mandatory
- +High switching costs once adopted — audit trail and workflow become embedded in org processes
- +Freemium model is smart — OIG checks are a natural free hook that builds trust before upselling
- +Low technical risk for MVP — public data sources, standard SaaS patterns, no ML/AI dependency
- !Slow sales cycles — compliance buyers are reactive (buy after audit findings), not proactive. Budget objection is the #1 killer.
- !Incumbent expansion threat — symplr, Verisys, or Medallion could bolt on the missing pieces faster than you can build credibility
- !Healthcare sales complexity — even $300/mo purchases can require security reviews, BAAs, compliance questionnaires, and 3-6 month procurement cycles
- !Domain expertise barrier — credentialing rules vary by state, payer, and org type. Getting the workflow wrong erodes trust fast.
- !Freemium conversion risk — compliance teams may use free tier indefinitely if it covers their minimum OIG check obligation
Industry-standard provider data collection and credentialing verification platform used by most US health plans. Providers self-attest data, payers verify.
Sanctions and exclusion screening service that checks OIG LEIE, SAM, state Medicaid exclusion lists, and other databases. Offers continuous monitoring.
Cloud-based credentialing and enrollment management platform for healthcare organizations. Automates primary source verification, tracks expirables, manages payer enrollment.
Modern API-first provider operations platform handling credentialing, enrollment, and licensing for digital health companies and staffing firms.
Free government exclusion databases that compliance teams manually check. OIG LEIE for federal exclusions, SAM.gov for debarment. Many orgs still do this manually with spreadsheets.
Week 1-2: Provider roster upload (CSV) + automated monthly OIG LEIE screening with pass/fail results and downloadable audit report. Week 3-4: Add SAM.gov screening, basic provider profile pages, and email alerts for flagged providers. Week 5-6: Role-based access (compliance officer vs. credentialing coordinator), task assignment for flagged results, and audit trail. Week 7-8: Dashboard showing screening status across all providers, expiring credential alerts, and basic credentialing checklist tracking. Ship free tier with OIG+SAM checks for up to 100 providers. Paid tier unlocks continuous monitoring, state exclusion lists, and team features.
Free: OIG + SAM screening for ≤100 providers, single user, monthly batch checks → Starter ($300/mo): Continuous monitoring, 3 users, state exclusion lists, basic credentialing tracking → Professional ($800/mo): Full credentialing workflow, unlimited users, role-based handoffs, custom checklists, API access → Enterprise ($2,000+/mo): Multi-location, SSO, custom integrations, dedicated support, payer enrollment tracking. Expansion revenue from per-provider overage fees and add-on state list coverage.
3-6 months to first paying customer. Expect 8-12 weeks to build MVP, then 4-12 weeks of free tier adoption and trust-building before first conversion. Healthcare buyers move slowly. Plan for 12-18 months to reach $10K MRR. The freemium hook accelerates awareness but doesn't accelerate procurement. First revenue most likely comes from a mid-size practice (200-500 providers) where the compliance officer has budget authority and felt pain from a recent audit or incident.
- “need to check providers at the same time, so everything feels fragmented”
- “different spreadsheets & different people responsible”
- “Leadership doesnt want to spend on new tools until something goes wrong but also expects everything to be airtight”
- “you stop trusting your own process”