Canada
Puerto Rico
USA
Belgium
France
UK
India
Client Background
A public healthcare system providing the best in healthcare and the latest in medical technology to the people throughout the world.
Client Need
Fragmented provider data across claims, directory, and credentialing systems led to inconsistent and unreliable provider records.
Repeated provider outreach for data verification increased provider abrasion and delayed onboarding and update cycles.
Inaccurate provider directories elevated CMS compliance and regulatory risk.
Manual data management processes limited timely updates and cross-system consistency.
Lack of a unified provider data foundation hindered operational efficiency, downstream business processes, and member experience.
Solution
Implemented a provider data modernization strategy using the 4L framework—Land, Link, Leverage, Learn to establish a unified and governed provider data foundation.
Integrated data from provider onboarding, credentialing, claims and billing systems, along with 7,800+ external sources, into a centralized provider data ecosystem.
Enabled API-based data ingestion and standardized data templates to streamline provider data capture and updates.
Introduced provider self-service capabilities to enable direct provider data maintenance and reduce administrative burden.
Deployed Master Data Management (MDM) capabilities, including:
- NPI-based and probabilistic identity matching
- Automated de-duplication rules
- Golden provider record creation to unify provider information across systems
Established governance policies for data ownership, stewardship, and ongoing quality management.
Enabled downstream use cases including accurate provider directories, improved claims adjudication, network adequacy analysis, and value-based care reporting.
Realized Benefits
~50% reduction in manual provider data entry, improving operational efficiency and reducing administrative effort.
~20% reduction in duplicate provider records, strengthening provider data integrity across systems.
>95% sustained provider data accuracy, supporting regulatory compliance and more reliable decision-making.
Faster provider onboarding cycles, accelerating provider activation and update turnaround.
Reduced claims rework, improving processing efficiency.
Enhanced member experience through more accurate provider directories.
Shift from reactive issue resolution to proactive data governance.
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