Case Study: a multi-state healthcare payer reduces prior authorization errors with 10Pearls

A multi-state healthcare payer cuts medical costs by $10M with 10Pearls

A multi-state healthcare payer faced significant financial losses and operational inefficiencies due to its manual, error-prone prior authorization process. Outdated technology and constantly changing clinical guidelines led to incorrect payments and delays in patient care. 10Pearls was engaged to address this challenge.

10Pearls implemented an end-to-end workflow automation solution using the Appian platform. This system centralized patient data and used intelligent decision trees to ensure consistent application of clinical guidelines, which improved accuracy and streamlined decisions. As a result, the payer achieved a $10M reduction in yearly medical costs by eliminating processing errors and saw a 15% reduction in service time, enhancing both financial stability and service delivery.