Reducing cost by 30% with Optimized Provider Data
Improving errors, enhancing compliance, and containing costs
About the Client
- Plan Type: Multi-Line (Commercial and Medicare Advantage)
- Plan Size: 400K members
- Geography: Midwest
Issue
A regional health plan serving more than 400,000 members was expanding rapidly but lacked the infrastructure to manage provider data effectively.
Slow turnaround times led to compliance gaps and violations of the No Surprise Act, resulting in penalty risks and provider frustration. Administrative inefficiencies increased costs and eroded satisfaction across the network.
The plan faced several key challenges:
- Data fragmentation across multiple, ungoverned systems.
- The composition of the Provider Network data caused the network to appear three times its actual size.
- Compliance violations tied to delayed updates and inaccurate directories.
- Manual, inefficient workflows with limited visibility and oversight.
- Rising administrative costs and declining provider satisfaction.
The plan needed a scalable solution to strengthen provider network operations, improve data accuracy, and ensure regulatory compliance while restoring confidence among its provider community.
Action
Sagility assessed the health plan’s provider data management and credentialing processes to uncover operational gaps and compliance risks. The team developed a comprehensive blueprint to modernize data validation, credentialing, and recredentialing — anchored by people, process, and technology. Within 90 days, Sagility launched a Provider Directory Validation program supported by a 10-member team in the Philippines.
Key elements of the transformation included:
- Integration of Provider Forward™, Sagility’s proprietary platform, with the client’s CRM and third-party databases.
- Automation of intake, outreach, tracking, and deduplication, creating real-time visibility and accuracy.
- End-to-end process reengineering to establish a single source of truth for provider data.
- Implementation of dashboards and reporting tools to support compliance, audit success, and penalty avoidance.
These changes laid the foundation for data transparency, faster turnaround times, and measurable quality improvements across provider network operations.
Impact
Sagility’s partnership transformed provider network operations from a fragmented, manual process to one that is streamlined and data driven. Automated workflows reduced manual errors, improved turnaround times, and strengthened audit readiness — with performance improvements of up to 89% and 95% across key metrics.
The health plan achieved measurable, data-backed outcomes:
- Turnaround time improvements: 54% in credentialing, 62% in recredentialing, and 83% in provider data management (PDM).
- Quality gains: 89% improvement in credentialing and recredentialing, and 95% in PDM.
- Cost reduction: 30% overall cost decline driven by labor arbitrage, automation, and end-to-end process reengineering.
These improvements strengthened compliance with federal mandates and improved audit success rates. Provider satisfaction also rose as communication and data accuracy improved — proving that intelligent data stewardship delivers measurable value in quality, cost, and compliance.
Improvements in provider data management (PDM)
Improvement in credentialing and recredentialing
Quality gains in PDM
Cost reduction
