PLAN TYPE
Large National Medicare/Medicare Payer
PLAN SIZE
~8.7M
GEOGRAPHY
Nationwide with significant presence in key Medicare markets across the U.S
98%
Compliance with turnaround-time commitments
98%
Quality performance across audited cases
91%
Reduction in inbound provider calls
98%
Inquiry resolution rate
Issue
This challenge was particularly pronounced among large provider organizations, revenue cycle management (RCM) companies, and third-party administrators (TPAs), which frequently managed inquiries involving multiple patients, claims, and accounts receivable issues within a single interaction. As a result, these organizations were often forced to reach out to the Provider Contact Center to seek resolution, leading to lengthy calls, repeated follow-ups, increased administrative burden, and limited visibility into inquiry status and outcomes. This escalating problem created an opportunity to replace the current provider interaction system with a more scalable, transparent, and efficient digital resolution model that could automate complex and bulk inquiries while reducing provider effort and contact center dependency.
Action
Sagility implemented HealthBridge Connect as an alternative digital resolution channel for provider organizations, (RCM companies, and TPAs managing complex, multi-patient and multi-claim inquiries. Rather than relying on phone calls, emails, and file-based exchanges to resolve issues that could not be addressed through traditional self-service portals, users were provided access to a structured workflow automation platform for submitting, tracking, and managing inquiries.
HealthBridge Connect enabled standardized intake, case assignment, supporting document exchange, status tracking, and written resolution within a single workflow. The platform was designed to support both individual and bulk inquiries, providing a scalable alternative to high-effort contact center interactions. A dedicated service team managed the work using defined service levels, quality controls, and performance management processes.
Impact
The implementation enabled the client to:
- Digitize complex inquiries involving multiple patients, claims, and accounts receivable issues.
- Provide a structured workflow for both single and bulk submissions from providers, TPAs, and RCM organizations.
- Deliver end-to-end visibility through inquiry tracking, status updates, and a documented audit trail.
- Measure operational performance through turnaround time, quality, resolution, and call-reduction metrics.
As adoption and operational maturity increased, service levels were enhanced by automating turnaround targets, reducing them from 6 hours to 4 hours for bulk inquiries and from 12 hours to 6 hours for individual inquiries, further improving responsiveness and provider experience.
This successful outcome positioned HealthBridge Connect as a digital alternative to provider contact center calls for complex inquiries that cannot be resolved through existing portal capabilities, which is the core value proposition of the pilot.
Other measured results included:
- Adoption by multiple provider organizations, including large provider groups, RCM companies, and TPAs, validating the demand for a digital alternative to traditional contact center interactions.
- 98% compliance with turnaround-time commitments, while progressively tightening service levels as the operating model matured.
- 98% quality performance across audited cases, ensuring consistent and accurate resolution.
- 91% reduction in inbound provider calls among participating provider groups, significantly reducing provider effort and administrative burden.
- 98% inquiry resolution rate, demonstrating the effectiveness of structured digital workflows for complex provider inquiries.
Based on the pilot’s success, the implementation demonstrated the viability of a digital-first provider servicing model for complex inquiries and established a foundation for broader provider adoption, deeper workflow automation, and integration with existing provider engagement ecosystems.
