Case Study: Large Healthcare Company achieves $10M annual savings and faster, more accurate pre-authorizations with Appian

Large Healthcare Company - Customer Case Study

A large, multi-state healthcare payer (more than $10B in revenue, 10 million members, 15,000 employees) faced error-prone, manual pre-authorization processes. Care coordinators relied on notepads and spreadsheets to interpret complex, frequently changing rules that vary by geography and plan, producing a 98–98.5% approval accuracy but leaving 1.5–2% error—amounting to tens of millions of dollars in inappropriate approvals for high-value procedures.

Using Appian’s low-code digital platform to automate utilization management, the payer captured up-to-date authorization rules, provided real-time decision support as advocates entered information, and auto-routed escalations for higher-level review. The solution processed over 1.2 million transactions in six months, cut service time by more than 15%, reduced medical costs by $10 million per year, improved accuracy and consistency of decisions, and shortened new-hire tool training from days to hours.