Automating for Digital Transformation
One of the nation’s largest health care insurers serves millions of people with individual, Medicare, and group health insurance plans for businesses and ranked on the Fortune 500 list in 2020 with a nearly $5-billion operating budget. It strives to improve healthcare making it more accessible to help people achieve livelong wellbeing.
Its highly manual and costly credentialing process required multiple, time- and resource-consuming outreach efforts to providers, often producing incomplete information. They needed a partner familiar with their operations to help apply a digital process solution based on high automation technology.
Leveraging Partnerships and Expertise for Innovation
Drawing on its industry expertise serving national and regional health insurance payers, Sutherland is applying its SmartCred platform – built in conjunction with the insurer – as the foundation of an end-to-end solution, transforming the insurer’s credentialing process into a robotics enabled digital solution.
SmartCred – a single common platform for achieving greater data efficiency and fidelity –is delivering analytics-based, omni-channel outreach to enable bi-directional data exchanges with the insurer’s health plan systems and integration with third party sources. Primary Source Verification is transformed from a manual process into a robotic process automation (RPA)-driven one. It also provides a cloud-based credentialing data hub to improve data quality and deliver timely, accurate updates to payer core systems facilitating compliance with state mandates and the federal Centers for Medicare/Medicaid Studies (CMS).
With SmartCred, the insurer realizes significant improvements including reductions in credentialing time from five days to two with quicker application review, verification, and decision making. With automated CAQH data ingestion and validation and fully automated credentialing, SmartCRED eliminates manual touchpoint providing better quality at a reduced cost. The fully integrated workflow system enables Omnichannel outreach for missing information while AI helps predict the outreach method for delivering the best result. The insurer is realizing a 50% drop in turnaround times with up to a 30% decrease in credentialing costs since implementing the solution.