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 Additionally, the reliance on outdated technology and manual data handling worsened these issues, with constantly changing clinical guidelines undermining the accuracy and timeliness of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
Related case studies
Healthcare
Improving Platform Reliability with Real-Time Monitoring
Real-time monitoring improved ServiceNow platform reliability with better device tracking, centralized support, and stronger operational visibility.
Healthcare
Modernizing Service Operations with ServiceNow CSM
A customized ServiceNow CSM solution streamlined healthcare case management, improved agent productivity, and created a more scalable service model.
Artificial Intelligence
Accelerating Clinical Knowledge Delivery with AI
An AI-powered knowledge delivery solution helped clinical teams access the right information faster, improving speed, accuracy, and decision support.
AWS
Improving Speed & Security Across Health Systems
Health system modernization improved speed, strengthened security, and created a more dependable digital experience across critical operations.
Healthcare
Accelerating Care Delivery with Intelligent Automation
Disjointed healthcare workflows were unified with intelligent automation, improving patient journeys, communication, and operational efficiency.
AWS
Transforming Diabetes Care with Cloud AI
Cloud AI transformed diabetes care with a scalable event-driven platform that cut infrastructure costs, reduced incidents, and improved response times.
Artificial Intelligence
Enhancing Claims Intelligence with AI Analytics
AI-powered claims intelligence improved visibility, sped decisions, and helped teams uncover patterns faster for smarter, more accurate claims operations.
Artificial Intelligence
Improving Patients Engagement With Conversational AI
10Pearls helped healthcare providers improve patient engagement with conversational AI that automated follow-ups, reduced clinician workload, and sped up care responses.
.Net
Medical Device Tracking
10Pearls modernized medical device tracking with real-time asset visibility, smarter inventory management, and faster field service decisions.
Healthcare
MSK Telemedicine Platform
A personalized MSK telemedicine platform improved plan adherence by 55%, reduced surgical referrals by 89%, and transformed patient care.
Ready to get started?
Contact us today to learn how we can transform your products or ideas into scalable solutions that drive business value and growth.