Case Study: Large Healthcare Company achieves streamlined provider enrollment and unified provider data with Appian

Automate Provider enrollment and maintenance processes, and integrate to critical data and core administration systems

A large, multi-state healthcare payer serving mainly publicly funded members (Medicaid, dual eligibles, CHIP) — with more than $10 billion in revenue, 5 million members and 4,500 employees — struggled with inefficient provider enrollment and maintenance. Provider data lived in four disparate systems and multiple databases, producing manual, disconnected workflows that limited access to critical demographics, credentials and licensing information and made regulatory compliance difficult.

By deploying Appian’s low-code digital platform the payer standardized and automated provider enrollment and data management and integrated disparate systems for real‑time access to accurate provider information. The solution improved network organization and credentialing-to-claims processing, reduced administrative and IT costs, enabled rapid scaling of value‑based reimbursement initiatives, and gave members better information for provider decisions while strengthening compliance and security.