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Supporting accurate member matching and data standardization with a modern stewardship user interface

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Background

A leading medical billing and claims intermediary partnered with Verato to overcome challenges in member identity management and data standardization. Their goals included accurately matching members, enabling downstream use cases like automated claims pricing and payment integrity, and reducing reliance on internal resources. They also sought a modern stewardship interface to streamline workflows, eliminate in-house development needs, and align with broader customer-centric initiatives. Furthermore, an aggressive timeline of under two quarters for solution design and implementation was a critical requirement.

By implementing Verato’s solution, the organization achieved significant outcomes, including improved member satisfaction through unified access to information, enhanced compliance and reduced risk with secure handling of PHI, and optimized resource allocation to strategic priorities. Standardized data enabled their Data Science teams to accelerate model development and product analytics, driving greater innovation and value. This collaboration highlights Verato’s ability to deliver transformative results, aligning with customer goals and supporting operational success.

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800k providers paid

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120M members engaged

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75% reduction in development and rollout time

Challenge

Accelerating implementation of a secure solution to address customer satisfaction issues

A medical billing and claims intermediary manages more than 15 million unique members across their entire platform and multiple business lines. The team grappled with siloed data across its various business units and product lines, leading to key challenges, including:

Customer satisfaction: Members were unable to access their information in a unified location, leading to dissatisfaction and increased strain on payer and company resources.

Compliance and Risk: The member-facing portals managed by the intermediary’s data intelligence contain Protected Health Information (PHI), thereby necessitating the highest degree of security and governance.

Resource Allocation: Building a member identity management asset from scratch would prevent this intermediary from achieving its goals in a timely, cost-effective, and best-in-class manner.

“The accuracy and ease of deployment of Verato’s platform have been game-changers. We’ve been able to meet our timelines and focus on strategic initiatives that drive growth.”

Data Management Team Lead

Solution

Built-in MDM, stewardship and accuracy

To address these challenges and reach their goals, this medical billing and claims intermediary selected Verato, the identity experts for healthcare. The Verato hMDM™ platform, the industry’s first purpose-built healthcare master data management solution, enabled them to obtain a complete and trusted 360-degree view of members and help them get identity right from the start with:

Accurate member matching and data standardization: Verato hMDM provided the company with the capability to accurately match members across various products and clean/standardize their data, enabling critical downstream use cases.

Rapid deployment and future-ready integration: Verato was quick and easy to deploy, fitting seamlessly into the company’s existing workflows and poised to handle future data sources and use cases. The company will have the API solution it is looking for, supporting existing and future integrations (Snowflake) and workflows, with real-time processing.

Modern stewardship user interface: A user-friendly interface that significantly improved the efficiency of internal resources, reducing the need for extensive internal development efforts.

Industry-leading accuracy: Verato provides an independently verified, industry-leading level of accuracy. This is crucial for managing thin, unstandardized data across customer sources and product lines. The unmatched accuracy of Verato, the highest in the industry, provides the company with a clear, standardized, and trusted view of each member.

Results

Satisfaction, risk reduction, and efficiency

The implementation of Verato led to substantial improvements for this medical billing and claims intermediary:

Increased member satisfaction: By providing members with a unified access point for their information, the company improved customer satisfaction and reduced strain on payer resources.

Enhanced compliance and reduced risk: The accurate and secure handling of PHI through Verato hMDM™ ensured compliance with regulatory requirements and minimized risk.

Resource optimization: The deployment of Verato hMDM allowed them to focus their internal resources on core initiatives, enhancing overall operational efficiency.

Data Science Advancements: The standardized data enabled the company’s Data Science teams to quickly and accurately build new models and drive product analytics.

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