The Hidden Costs of Manual Roster Management:      A Payer’s Journey Before AI

The Challenges of Manual Provider Roster Management 

Imagine the routine of processing provider rosters manually. Health plan teams face the daunting task of assessing data in files ranging from 100 to 10,000 lines, containing 100 to 200 columns. The first day is spent merely formatting the file into a usable format—a full day’s work just to create a flat file. The next day involves cross-referencing provider names with an existing database, often taking another 24 hours.

By the third day, narrowing down the roster to a more manageable list raises critical questions: Which networks and pricing should be added? Each roster can be unique, requiring a review of complex contract handbooks. If an unfamiliar specialty arises that is not included in the handbook, such as a helicopter paramedic, the employee will need to consult with the management team on how to handle it, further extending the timeline.

Once the files are ready to be loaded into the system, delays of several days are common. Small errors, like typos in pricing codes, can lead to significant setbacks, leaving employees juggling multiple files and struggling to keep track of their progress.

The New Way: AI-Driven Efficiency

With the application of technology using knowledge-enhanced large language models (LLMs), health plans have started to transform how they manage provider data. Now, instead of spending days on individual files, AI can process multiple rosters simultaneously, freeing teams from tedious manual tasks and allowing them to focus on other important business priorities. 

Imagine walking into the office to find twenty files already processed and ready for review. What used to take days can now be accomplished in just hours. Teams can quickly verify the AI's accuracy and generate output files, all while having the flexibility to focus on more strategic tasks, such as building and strengthening relationships with providers.  

AI’s Necessity in Today’s Healthcare Landscape 

In today’s complex healthcare landscape, adopting AI solutions is not merely an upgrade—it’s imperative for sustained success. Health plans that do not adopt these technologies risk being left behind, as inefficiencies and errors in their data continue to grow. On the other hand, those that embrace AI are positioning themselves for success.

AI allows organizations to be more agile, responsive, and accurate. As the healthcare landscape continues to evolve, with new regulations, specialties, and demands from patients and providers, AI ensures that health plans can keep up. It streamlines processes, reduces errors, and allows employees to focus on what truly matters: improving the quality of patient care and the efficiency of operations.

The transition to AI is not without its challenges. Like any major change, it requires an investment of time, resources, and training. But the payoff is undeniable. Health plans that integrate AI into their provider data management processes will see improvements in every aspect of their operations, from data accuracy to employee satisfaction to provider relationships.

Ready for the Future? Embrace AI Today 

The days of manually processing provider rosters are numbered. With AI, health plans can revolutionize their operations like roster management, making them faster, more accurate, and more efficient.  

Learn how we are changing the game in roster management