Case Study: Large Health Plan Company catches 342 exclusions in 2 weeks with ProviderTrust

More Than 300 Exclusions Caught in First 2 Weeks of Automated Monitoring

Large Health Plan Company, a national leader in dental and vision benefits serving 27 million members, was relying on a manual exclusion screening process that required staff to review thousands of potential matches each month. This created a risk of human error, high labor costs, and incomplete verifications across multiple lines of business. ProviderTrust helped the organization move away from that risky process by introducing automated, exact-match exclusion monitoring.

With ProviderTrust’s smarter exclusion monitoring and enhanced primary source data, the health plan was able to automate screening across federal and state exclusion sources while maintaining compliance requirements for each line of business. In just two weeks, ProviderTrust identified 342 verified exact-match exclusions, including 211 exclusions found through its enhanced data capabilities, and auto-resolved more than 40,000 potential matches, saving hundreds of hours of monthly labor.