Case Study | Healthcare Payer
Automated Utilization Management Platform
Supporting clinicians managing prior authorization with automated workflows, driving efficiency and accuracy in utilization management.
Overview
A large multi-state healthcare payer relied on manual processes to manage prior authorizations. These manual workflows, combined with ever-changing guidelines, led to errors and resulted in tens of millions of dollars in incorrect payments due to inaccurate data. 10Pearls automated the prior authorization process, reducing errors and losses due to inaccurate data.
$10M reduction in
yearly medical costs
by eliminating processing errors
Improved service delivery
with a 15% reduction in service time
Challenge
Inefficient and error-prone management of prior authorizations led to significant financial losses from incorrect payments caused by inaccurate data. The complex authorization process delayed patient care and increased administrative workload. Additionally, the reliance on outdated technology and manual data handling worsened these issues, with constantly changing clinical guidelines undermining the accuracy and timeliness of authorizations.
Solution
10Pearls implemented comprehensive end-to-end workflow automation using Appian, a leading business process automation platform. This solution centralized patient data throughout the entire authorization process, eliminating the need for manual data handling and reducing the risk of inaccuracies. By incorporating intelligent decision trees and business rules, the system ensured that clinical guidelines were consistently applied, improving data accuracy and streamlining decision-making. The automated workflows reduced administrative burden, minimized delays in patient care, and optimized resource allocation, ultimately enhancing both operational efficiency and financial stability for the healthcare payer.
Customer
Multi-state healthcare payer
Services
Tech Stack
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