Case Study: Health Payer/Provider Onboarding/Network Growth

A recognized name in medical insurance takes on substantially reducing provider onboarding time and improving provider management with Salesforce. Tectonic standardized and automated much of the provider prospecting and onboarding processes. Salesforce was configured to allow provider data from multiple states to be managed and also completed an integration to a credentials verification system. This has reduced the overall cost and reduced the time to onboard by over 70% versus the previous highly manual process.

What Tectonic Did

Provider onboarding process was reduced from 75-90 days to 2-3 weeks for one provider
The customers using this solution have the reports and measures to take control of their provider networks and proactively manage them

Who Tectonic Did This Work For

Primary Payor – Ancilliary Payor:
- Solution has been implemented in multiple payer organizations.
- One of the Clients is one the largest Blue health insurance companies in United states
- Another Client provides ancillary insurance services including life, dental, disability, vision and others to Blue partners and others in many states.

The Business Problem

Adding new providers and maintaining the network of providers was a difficult manual process.
The networks that providers belong to is constantly changing
Growing the provider network to meet the needs of the customer requires constant adjustment
The onboarding process for bringing new providers to the network was often taking 75-90 days

Implementation

Using Salesforce, Tectonic customized a provider onboard and management application that allowed client to work with multiple payor partners in different states
The following business processes were implemented in Salesforce
- Prospect Management
  - Salesforce allow client user to upload Prospect for all for states using a simple file uploading process
  - It allows to check for duplicate records by matching it with existing data
  - Deduplication of the records is managed at run time in the background automatically
- Practice/Provider Management (Account Management)
  - Salesforce provides the ability to convert the Prospects into Practice/Provider
  - All Practices and Providers from different states are differentiated on the basis of BPIC (Business Provider Identification Code) field
  - All relevant/associated information like locations, affiliations, specialties, networks etc for each record is visible on a single page on Salesforce platform
- Credentials Management
  - Team Tectonic has automated the Practice/Provider credentials verification process (verification of skills, training and education)
  - Salesforce data is automatically updated through an integration with VerifPoint which allows verification through an automated process
- Affiliation Management
  - Affiliation management is a way of showing all the associated
    - Locations
    - Specialties
    - Networks of a Provider/Practice
  - Affiliation is basically a main Object defined in Salesforce org which acts as a binding object between all Objects to meet clients business requirements.
Reports and Dashboards
- We have extensive use of the Salesforce reporting and dashboard capabilities
- Some of the areas where extensive amount of Reporting is used are:
  - Credentials
  - Prospect upload
  - Affiliation