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Sutherland Healthcare Group Created with Sketch.

Provider Data Management

Data Cleansing and Verification (DCAV) services

Health plans have more data than ever before. But more important than the quantity is the quality of their data. DCAV is often necessary to bring consistency to health plan’s data, especially when it has been lifted from numerous, disparate data systems and sources.

Sutherland’s DCAV solutions provide accurate, up-to-date provider information and utilize a combination of RPA, web search validations, and direct provider outreaches to achieve the highest accuracy in the most cost-effective and timely manner.

Credentialing

Members know very little about their doctor other than what they see hanging from an office wall. Medical credentialing is increasingly important because it’s the one process that allows members to gain trust in their health providers. Through data collection, primary source verification, and committee review by health plans, members are assured of their health provider’s qualifications and experience.

Sutherland supports health plans in the collection of primary source verification documentation, outreach services for missing information, automates data entry, and provides complete credentialing packets that are ready for health plans to review.

Provider Updates and Maintenance

Provider directories are only as accurate as the underlying provider databases maintained by the health plan. Sutherland professionals transform provider updates and changes from multiple channels into reliable data across multiple systems. Our teams touch over 300,000 provider records every month and utilize state of the art tools to maximize quality and productivity.

Sutherland brings a digital touch to setting up new providers, processing changes, terminations, demographic updates, and completing all of these tasks in a timely manner. Through our automation platforms, we’re able to increase the speed of updates and improve the overall quality of all health provider information.

Provider Recruitment

Health plans are racing to capture as many new, profitable members as possible. However, a key long-term success factor will be quickly recruiting and onboarding high-quality physicians. Finding, attracting, and partnering with high-quality physicians is a key component to improving the member experience and the overall success of the health plan.

Sutherland provides exceptional recruitment programs by leveraging our portfolio of contact center platforms and highly-qualified professionals to work with all types of health providers. We create a strong connection with recruited physicians, explaining the health plan’s contract terms and working closely with them to answer any questions they have and overcoming any objections.

The impact (value, savings)
  • Leverage Sutherland’s single source of provider data truth
  • URAC accredited sites in the US and in India
  • Cost savings through the automation of provider data management processes
Our experience
  • 28M annual payer transactions
  • 3.3M annual provider credentialing and annual transactions
  • Four of the top five US health plans are PDM clients
  • 15+ years’ experience with 1,500 dedicated PDM employees
Who we help
  • Large, national health plans
  • Regional and BCBS health plans
  • Government health insurance programs
Our differentiators

URAC accreditation in multiple geographies

Being URAC accredited means we’ve passed one of the most rigorous examination of our systems, processes, and performance to ensure we are providing services in a manner that meets high quality criteria and standards. Sutherland is not only URAC accredited but is one of the few providers with accreditation in US and non-US sites.

Early adoption of robotics and automation

We saw the importance of automation early on, which is why Sutherland created a dedicated healthcare RPA center of excellence in Hyderabad, India years ago. Now, our dedicated team of RPA employees works to continuously improve back-office services through automation.

Opening/Introductory

A health plan’s data powers every aspect of their operations. If that data is outdated or inaccurate then it’ll negatively impact a health plan’s bottom-line and, most importantly, hurt their member experience. Often times, health plans are using outdated technology or inefficient processes to handle the maintenance of their provider data.

Sutherland’s provider data management (PDM) solutions leverage robotic process automation (RPA) and proprietary platforms to improve the speed of data updates and guarantee that provider databases are as up-to-date as possible. The end result is more accurate data and lower operational costs for health plans.

Our thinking (White papers, blogs)
Our work (Case studies)