Case Study: Healthcare

Leading physician network provider improves data accuracy with PDM, saving nearly $1 million

HGS accelerated collections, reduced receivables, and avoided write-offs

Overview

A leading physician network provider saved nearly $1 million, improved data quality, and reduced provider abrasion with HGS’s Provider Data Management (PDM) and credentialing.

$800K in annual savings

$155K in credentialing cost savings

90K updates/month in six months

Client background

Access to care that affects Star ratings is a challenge for many payers. One leading physician network provider was looking to reduce costs and improve the quality of their PDM and credentialing solutions.

Business challenge

As a provider of physician networks, the client experienced a high propensity of provider data errors as a result of their agents manually keying in data. The importance of data accuracy drives reduced provider abrasion and potential impacts to Star ratings. As healthcare companies increasingly look to improve the integrity of their data, the client sought HGS’s help to increase savings and improve the quality of their provider database management.

The solution

HGS provided services to accelerate cash collections and reduce receivables and excessive bad debt write-offs.

Leverage PDM solution Provider Forward

To address the client’s key objectives, HGS leveraged the proprietary PDM solution Provider Forward, a workflow management tool featuring automation and bot deployment. The solution is built with a non-invasive automation technology, based on multiple validation rules to ensure clean entry into the master database. This solution helps identify and translate unstructured data into structured data. The intelligent bots pick up the cleaned data and update the client’s proprietary system, applying appropriate business rules. The automation includes scrubbing of rosters supported by bots that capture key data for insights. Data collection and verification are performed outside of the client’s core systems. The tool can provide cleaned output files in most industry-standard formats.

Introduced AI-powered CRM solution

HGS has also introduced a well-integrated CRM that uses machine learning to improve the connect ratio and a predictive model algorithm that prioritizes the queue to increase successful data collection. This is supplemented by a network management solution with the provider credentialing people-process-technology firepower.

Results

HGS delivers provider data updates and maintenance from Hyderabad and Bangalore. Here are a few results:

$800K in annual savings with PDM support

$155K in credentialing cost savings, with a 50% reduction in team size

99% database quality of transactions processed through automation maintained

50K – 90K increased updates/month within six months

70% manual steps reduced with double processing output — eight transactions per hour

Increased productivity with no additional hiring

Global locations

USA • India • Philippines • Jamaica

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