The Challenge
Before collaborating with Perspecta, the health insurer was facing urgent data management challenges due to low provider data validation rates. With only 25.61% of provider records validated, the organization risked falling short of CMS regulatory requirements and delivering inconsistent member experiences. Manual processes were proving inadequate for the scale and complexity of their provider network, leading to potential network inaccuracies, regulatory exposure, and operational inefficiencies that impacted both compliance and care quality.
The Solution
Recognizing the importance of data integrity and scalability, the insurer evaluated solutions capable of delivering rapid, high-impact results across millions of records. Perspecta's AI-driven data management platform was selected for its robust capabilities in automated provider data validation, real-time cleansing, and regulatory readiness. Implementation involved seamless integration with existing IT infrastructure, allowing the insurer to automate validation workflows, eliminate manual errors, and connect disparate data sources into a single source of truth. By leveraging Perspecta's advanced machine learning and automation, the organization was able to proactively manage directory accuracy and compliance at scale.
The Results
Within a 237-day span, the insurer achieved a provider data validation rate increase from 25.61% to 82.41%, successfully updating more than 7 million provider records. This rapid transformation delivered a substantial reduction in regulatory risk, improved network transparency, and enhanced operational efficiency. The validated, accurate data foundation established by Perspecta supports ongoing regulatory compliance, optimized provider search experiences, and better outcomes for members relying on accurate healthcare directories. The project stands as a benchmark for scalable, technology-driven success in healthcare data management.
