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.
