Provider Data Management: Process Innovation and Technology Result in Cost Savings
About the Client
The client is one of the largest PPO networks in the United States. This company leverages technology and data analytics to provide healthcare cost management solutions. The client specializes in providing claim cost management solutions, generating billions of dollars in annual savings for commercial, property and casualty, and government payers of claims. At this point, we had been working with this network for three years.
Challenge
As part of Vee Technologies’ provider management services, we handle roster updates for this client. At the time, we were reviewing hundreds of rosters each month that were all formatted according to different templates that had to be matched manually to the web portal.
For instance, a group of providers might send all its providers’ names, addresses, and other data to us in an Excel file, while another group of providers might send a Word document or a Google Doc with this information. One group might format their information with their providers’ last names first and then first names, while another might do the opposite. This meant that the information we were given was rarely formatted the same way.
To deal with all these different formats, we had to transfer the information into the provider data portal by hand. This meant that we had to compare what is on the file against the client’s portal, and whenever we could not identify a match, we had to update the record manually. This required our team to spend long periods of time examining each individual record, comparing it to the portal, and, finally, identifying any necessary changes. We realized that this tedious task cost our client valuable time and money, so we came up with a solution without being asked. We presented our idea to the client and got to work.
Solution
Vee Technologies’ operations and IT teams worked together to create a custom workflow and re-engineer the process, resulting in only meaningful updates being sent to end-users for processing. To start, we designed a template with all the possible data and loaded the roster receipts into our template. Using this template, we compared the information against the clients’ database and performed updates and additions as needed.
Through our engineering process, we discovered that 60% of the rosters did not need to be worked on in the first place. We divided the remaining 40% into two groups: rosters that need to be modified in the portal and rosters that need to be added to the portal. Then, these were assigned to individuals on our team for manual data transferring, resulting in increased productivity and higher quality of service.
Benefits
Our solution reduced 250 hours of manual work to just 48—a dramatic change that revolutionized the roster update process. Our solution only took a month and a half to implement, greatly impressing our client and freeing up valuable time. Before we presented our idea to the client, it did not know that creating such a major change to the system in such a short turnaround time would be possible. Now that we have experience with this custom workflow, we are confident that we can recreate it with even greater speed, accuracy, and quality.
