Provider credentialing & network · Provider data and payer enrollment platform
Madaket Health
Madaket Health is a Cambridge, Massachusetts, company whose provider data platform automates payer enrollment, EDI and EFT enrollment, rosters and directory updates between providers and health plans.
Strong fit
- Provider groups and health systems that file large volumes of payer enrollments
- Health plans that need accurate provider directories under the No Surprises Act
- Billing companies and MSOs that need EDI and EFT enrollment at scale
Weak fit
- Small practices that want credentialing done for them by a service team
- Buyers who want primary source verification as the main product
- Buyers who need a posted price
Bottom line
Madaket Health is a reasonable choice for provider organizations and health plans that move large amounts of enrollment and directory data between each other. Its payer connections and long history are real strengths. Small practices that want full-service credentialing will find simpler options.
Score breakdown
Weights: Outcomes 35% · Product 30% · Implementation 20% · Pricing clarity 15%.
Jim Dougherty, Ted Achtem and Benedict Dsilva founded Madaket Health in Cambridge, Massachusetts, in 2012 to cut the paperwork between health plans and providers. Megan Schmidt, a former health plan executive, became chief executive in September 2025. Its investors include Qiming Venture Partners and Salesforce Ventures.
The platform keeps one profile for each provider and uses it to file payer enrollments, EDI and EFT enrollments for claims and payments, and roster updates. Madaket says it is connected to more than 4,000 payers and that its EDI connections reach 85% of US providers.
Provider Data Exchange is the health plan side. It takes provider data from groups, checks it and keeps plan directories current, which helps plans meet the No Surprises Act rule to update directories within 48 hours. Analytics show where enrollments are stuck and which data is wrong.
Madaket serves health plans, health systems, telehealth and dental groups, clearinghouses and EHR companies, and its platform is sold on AWS Marketplace. It holds SOC 2 Type 2 certification.
Madaket does not post prices or many customer results. It works best for organizations with steady enrollment volume and staff to run it, not for small practices that want a service team to do the work.
Medallion fits digital health companies and provider groups that want credentialing and payer enrollment with specialist help. CertifyOS fits health plans and digital health companies that want credentialing, licensing and monitoring through an API.
Competitor landscape
| Vendor | Overall | Ease of implementation |
|---|---|---|
| Medallion | 7.7 | 7.3 |
| CertifyOS | 7.7 | 7.4 |
| Madaket Health | 7.0 | 6.8 |
Pricing
| Item | Detail |
|---|---|
| Model | Madaket Health sells its platform by subscription to providers, payers and partners, with pricing by contract. |
| What usually drives cost | For Madaket, cost depends on the number of providers and enrollments, the modules you use, such as payer enrollment, EDI and EFT enrollment or Provider Data Exchange, and any integration work. |
| What to ask before you buy | Ask Madaket for a price per provider or per enrollment, which payers it submits to electronically in your states, and how roster updates flow to the health plans you work with. |
| Published pricing | Madaket Health does not publish a price list. |
Methodology
| Weight | Factor | What it measures |
|---|---|---|
| 35% | Customer outcomes | Whether buyers get measurable operational or clinical-workflow results after go-live |
| 30% | Product | Capability depth, reliability, and fit for the job the category buys |
| 20% | Implementation | How hard it is to stand up, integrate, train, and stabilize |
| 15% | Pricing clarity | Whether a buyer can model total cost without a mystery quote |
| Label | Meaning |
|---|---|
| Highly recommend | Strong outcomes and product with manageable caveats |
| Recommend | Solid fit for the right buyer; know the tradeoffs |
| Conditional | Only with a specific use case or heavy caveats |
| Not recommended | Avoid for most buyers in this category |
Read our full methodology for how we weight scores and assign recommend labels.