The Challenge
Streamlining And Accelerating Credentialing
As one of the largest commercial health plans in the US with 22 million members and more than $68 billion in revenue, our client knows the importance of accurate data. Their processes for data collection, cleansing, credentialing, and contract loading needs to be seamless and efficient so members can access the care they need when they need it.
However, our client was struggling with legacy infrastructure that impacted processing times and accuracy, and contributed to high operating costs, provider churn, and network data gaps.
The company needed a way to integrate, streamline, and optimize their processes to automate provider data cleansing, credentialing, and contract loading in an efficient and scalable manner.
The Solution
Platform-Based Automation for Optimal Operational Efficiency
Leveraging our unique combination of market-leading technology and business process excellence, we deployed a suite of AI-driven solutions to introduce automation to our client’s operations.
First, we leveraged our proprietary credentialing platform, SmartCred™, to create a tailored solution for automating provider data cleansing and credentialing. This was delivered through an “as a service” model, enabling clients to focus on their strategic priorities.
We then deployed our proprietary automation platform Sutherland Robility, to optimize processing times, improve accuracy, and streamline administrative tasks such as job scheduling.
The Outcome
Enhancing Credentialing Time, Compliance, and Provider Engagement
The advanced AI and analytics capabilities of the SmartCred™ platform accelerated credentialing processes, reducing end-to-end credentialing time from the industry standard of eight days to just two. This rapid improvement drove immediate, measurable results, enhancing overall efficiency. Through automation, the client streamlined administrative processes, freeing up resources and reducing costs.
Our approach delivered tangible business outcomes, including enhanced regulatory compliance, improved tracking, and increased responsiveness. It also bolstered real-time network knowledge and management, closed network data gaps, and significantly improved provider outreach and engagement.
That’s digital performance unlocked, and measurable results delivered!
Processing with no human touch
Reduction in non-response rates
Faster credentialing compared to industry average
Accelerate your Healthcare Transformation
Services
Automation, Sutherland SmartCred™
Industry
Healthcare
