Virtusa Provider Lifecycle Management (PLM)

The Passing and subsequent enforcement of the No Surprises Act by Congress mandates all healthcare provider directories have to be updated by 1 January 2022 and thereafter regularly, every 90 days. Health insurance payers face many challenges in onboarding providers to their networks. This is primarily due to the involvement of multiple departments using different applications and systems. This is further amplified by the lack of one unified platform where the various user groups can work on the provider onboarding process. All these business process delays have resulted in the Provider onboarding time taking at least 90 days on average, the Provider falling out of the contracting process, Operational inefficiencies, Poor data quality resulting from many handshakes between the departments, Low physician/provider satisfaction, and high operational costs.

The business problem is again reflected in the servicing of onboarded providers. Frequent provider data updates are often missed resulting in retaining incorrect provider information in the System of Record. All of these results in Payers having inaccurate provider information on the Find Doctor pages on their Websites and Mobile apps, failing to comply with Federal, State, and other regulatory requirements.

• LOB specific SLA’s and business rules, properties
• Client specific changes to screen layouts, fields
• Prospecting, Credentialing, Contracting and Configuration workflows
• Delegated and Non-Delegated provider specific process flows
• Business flow for onboarding with automated audit rules
• Automated validations and checks
• Reusable integrations for SSO, Claims, Authorizations
• Proprietary extension of provider data model
• Provider data model, robotics, integration, workflow, & case management