Case Study | Healthcare

A healthcare client increases turnaround time on credentialing by 200% with Sutherland’s advanced, automated credentialing solution.

Services Digital Engineering Services
Industry Healthcare
JULY 10, 2024

The Challenge

Addressing Inefficient and Time-Consuming Tasks in the Credentialing Process

Our client is one of the largest health insurance providers in the US, with over $150 billion in revenues and 102,000 employees nationwide.

They struggled with inefficiencies and low productivity owing to the cumbersome tasks involved in credentialing. These included having to manually download applications from the CAQH website, labor intensive data extraction processes to verify information, and no automated way to gather missing data.

The Outcome

Accelerating Processes and Improving Patient Care with Automated Credentialing

Sutherland’s strategy focused on boosting efficiency. As a first step, we implemented advanced technology coupled with AI-driven algorithms to automate the downloading and review of credentialing documentation from the CAQH website.

Through SmartCred, we further optimized each step of the process. This involved over 40 Smart Primary Source Verifications performing automated CAQH integration, state license verifications, sanctions monitoring, and more. The online verification system eliminated manual tasks, enabling real-time verification and greatly expediting the creation of credentialing packets.

The automated processes and efficient workflows resulted in a 200% increase in credentialing turnaround time and a 10% reduction of back-office costs. The client was able to onboard new providers faster and continue serving patients without delays related to the credentialing process.

A Centralized
User Management Solution

Starting by evaluating existing automation efforts, we leveraged our Sutherland RAPID model to re-evaluate our client’s use cases by replacing their existing RPA solution software with our end-to-end hyperautomation platform Robility. We used our Sutherland Robility platform to connect disparate systems across the business and deliver a more efficient workflow for our client. We created a one-window solution for all Claims First Notice of Loss (FNOL).

We utilized Robility's native OCR, RPA, workflow, AI/ML and digital command center components to increase speed-to-market and derive more value from use cases. The Robility hyperautomation platform centralized the user management solution across various applications. This allowed us to effectively manage user roles and application access management while dramatically increasing productivity and reducing overall cost of both licensing and operations.

Want to discover how Sutherland can help you transform your credentialing process?

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