The customer
Health plans managing provider data across disconnected systems.
The problem
Provider data lives in credentialing, the claims database, NPPES and beyond, with no golden record and no shared workflow. Onboarding is slow and paper-heavy, nothing keeps the data clean, and the result is claim denials, audit exposure, Star Rating drag and inaccurate directories that hurt member access.
What we built
We connect the full provider lifecycle on the Microsoft cloud: centralize every provider into one governed record, automate onboarding, credentialing and issue resolution, and layer agentic AI to monitor performance and keep the network current and compliant.
What changed
- One golden provider record across credentialing, claims and NPPES
- Automated onboarding and issue resolution instead of manual handoffs
- Continuous compliance and network-adequacy monitoring
- Cleaner data, fewer denials and faster provider payments
- Accurate directories that improve member care access
- Proactive Star Rating and performance management
- Reduced manual FTE labor cost and audit risk
Built with
- Dynamics 365 Sales
- Power Platform
- Dynamics 365 Customer Insights – Journeys
- Dynamics 365 Customer Service
- Power Automate
- Copilot Studio
- Copilot for Sales
- Azure Data Services
- Microsoft Fabric