Case Study
Use Cases for Healthcare Payers: Provider Network and Data Management
Use Cases for Healthcare Payers: Provider Network and Data Management Automate Provider enrollment and maintenance processes, and integrate to critical data and core administration systems. CUSTOMER PROFILE • Large healthcare payer operating in multiple states • Primarily public funded program members (Medicaid, Dual eligibles, CHIP) • Over $10 billion in revenue, 5 million members, 4500 employees CHALLENGES Inefficient Provider enrollment and maintenance with multiple manual steps and disconnected systems: • Lack of standardized processes • Data residing in four disparate internal systems and multiple databases • Provider data (demographics, credentials, licensing, specialty) not accessible to the critical business processes affecting payer’s relationships with customers, includi