70% Reduction in Provider Enrollment Time for One of the Largest Healthcare Systems

Industry: Healthcare | Services: Business Process as a Service

Client Overview

Our client is a leading non-profit healthcare system in the Northeast, dedicated to serving over two million patients each year. Their extensive network features 20+ hospitals, 1,000+ outpatient facilities, and more than 15,000 affiliated physicians providing comprehensive care across all major specialties, including behavioral health, dental, and vision.

The Challenge

The client was facing multiple challenges in their payer enrollment and credentialing process.

• Slow and Inefficient Operations: The existing process, managed by a previous vendor, lacked visibility and accountability. Workflows were clear, and follow-ups were inconsistent.
• Manual and Error-prone Tasks: Paper-based applications led to incomplete or incorrect submissions, requiring multiple rounds of rework.
• Delayed Communication: A lack of timely coordination between the incumbent team, payers, and internal staff resulted in enrollment delays, directly impacting reimbursements.

The client needed a partner who could streamline the process, reduce administrative friction, and ensure providers were enrolled quickly and accurately.

Sutherland Solution

Already trusted to manage all government payer enrollments, Sutherland expanded its role to include commercial payer enrollment services as well, which covered an additional 30+ dental, vision, behavioral health, and medical payers.

Our proactive approach combined process excellence, digital enablement, and collaborative governance to transform the experience.

1. Pre-Submission Audit Program
   We implemented a robust audit program and feedback framework to ensure every application was complete and accurate before submission. This proactive measure drastically reduced payer rejections and development requests.
2. Stronger Collaboration and Oversight
   Regular review meetings with cross-functional teams at the client’s organization improved visibility into any high-profile or profiles with outstanding AR, and accelerated the resolution of outstanding enrollments.
3. Early Credentialing for Faster Enrollment
   We reduced the overall enrollment turnaround time (TAT) by requesting credentials early in the enrollment process and by introducing Medicare surrogacy. The eligible providers were enrolled within 2 days—a 5X improvement over the traditional 10-day enrollment processing time of Medicare from submission in PECOS.

The Outcome

With over 38 years of credentialing experience and the SmartCred® automation platform, Sutherland helped the client streamline the enrollment process across medical, behavioral health, dental, and vision. By automating manual steps, enhancing communication, and standardizing workflows, we helped the client reduce paperwork, eliminate delays, and ensure compliance, which resulted in faster reimbursements and more satisfied providers.

We achieved an average of 6 days of provider enrollment, meeting the payer turnaround time target, against the initial goal of 15+ days. We also reduced Pages to Provider turnaround time from 10 days as a target to an average of 5 days. Overall, we enrolled 2,400 providers through Medicare surrogacy.