Vitusa’s Provider Lifecycle Management is a unified solution with differentiated capabilities that modernizes all aspects of complex Provider relationships for a Payer and/or Provider Operations. It enables complete, zero-touch automation in the provider onboarding cycle, from data intake, to credentialing, to loading demographic and pricing data into the system. . This presentation was made by Baskar Mohan, Senior Director, Healthcare – Virtusa, and Greg Aaron, Senior Client Executive - Pegasytems at HIMSS 2018.

1. 1
Smart Credentialing Digital
Platform Leveraging Pega
February, 2018

2. 2
01 Provider Challenges
02 Virtusa’s PLM Solution
03 Why Pega and Virtusa
04 Success Stories
Agenda
2

3. 3
INTRODUCTIONS
Baskar Mohan
Sr. Director, Healthcare
Virtusa
Greg Aaron
Sr. Client Executive,
Healthcare Providers
Leads VirtusaPolaris’
Payer/Provider teams
10+ years of Pega
implementation experience
20+ years of healthcare
experience
Former Retina Surgical 1st
Assistant and Ultra
sonographer
25 Years in Health IT

4. 4
Hospitals Face Significant Challenges In Managing Provider Engagement and Data
PROVIDER CHALLENGES
PROLONGED
ONBOARDING
HIGH COSTS ON
MAINTENANCE
OPERATIONAL
INEFFICIENCIES
LOW PROVIDER
SATISFACTION
UNSTRUCTURED
PROVIDER OUTREACH
MANUAL ROSTER FILE
GENERATION

5. 5
Healthcare Organizations Face Significant Challenges In Managing
Their Provider Engagement And Data
PAYER CHALLENGES
Potential for to reduce
onboarding time by ~50%
Potential to save ~$5M
annually due to unified
platform
Potential to increase
throughput by ~40% through
automated PSV
Potential to drastically
improve provider satisfaction
and effective collaboration
Effective Provider
Communication
Reduce manual effort by 90%
and save over $2M in costs
annually

6. 6
Provider Lifecycle Management, a critical business function for a Payer and or
Provider Operations
PLM OVERVIEW
RECRUITING
Identifying and Recruiting
Providers to join you
 Manage the Interview
Process
 Collect Necessary
Documents
 Complete Salary
Negotiations
SERVICING
Managing the on-going
maintenance needs
 Provider Reporting
 Provider Education
 Network Assessment
 Member Portal Setup
 Member Campaigns
CREDENTIALING
Validating the credentials
of the providers, before
they can be on-boarded
 Primary Source
Verification
 Sanctions Check
 Approve / Reject
 Notifying Plans
(Roster File updates)
ON-BOARDING
Collaborating with doctors
to collect the necessary
docs for timely setup
 Practice Setup
 Marketing
 Directory Updates
 Setup Payroll / Billing
 Reallocation
assistance

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Managing Provider Relationships Is Expensive, Inefficient And Time
Consuming and there is potential to Automate these Processes
COMPLEX PROCESSES
Team collects appropriate
documents necessary to
complete credentialing
and configuration
Setup team completes config-subcase by
loading Demographic and Pricing data
into internal systems (EMRs, Claims, etc.)
Cred Specialist completes the
cred-subcase by completing
the Primary Source
Verifications (PSV) for the
providers
PSV Sites
Provider submits
application (Privileges)
PROVIDERS RECRUITING
TEAM
HOSPITAL EXECS /
BODs
CREDENTIALING
TEAM
SETUP TEAM
After agreement is reached with
Provider, the recruiting team stars
gather information for Credentialing
Case is submitted
to the Board of
Directors for
Approval
Welcome Letter, Provider
Directory Updates, “Final
Signature”
1. RECRUITING 2. CREDENTIALING
3. ON BOARDING
Provider gets recruited or
requests to join the
Healthcare organization
(Membership)
CRM
TEAM
Continue to service providers – manage
surveys, audits, roster file updates,
communication, utilization and
performance measurements, etc.
Provider
Communications
4. SERVICING
Approval
Decision

8. 8
PLM Was Built on Pega’s Foundation for Healthcare
ENTERPRISE PLATFORM FEATURES
Customer
Engagement
Digital
Process
Automation
Pega Foundation for Healthcare
Customer
Service for
Healthcare
Sales
Automation for
Healthcare
Pega
Marketing
Product
Composer
System
Claims
Automation
Pega
Care
Management

9. 9
Leverage Pega BPM and Robotics to seamlessly automate the entire
credentialing process
SMART CREDENTIALING
AUTOMATED PSV
Leverage Robotics to perform automated
PSV based on Provider Type, Specialty etc.,
DOCUMENT CHECKLIST
Business configurable SMART document
checklist based on Provider Type, Specialty
etc.,
PROVIDER OUTREACH
Auto trigger Provider outreach and
remainders for missing information and
documents
SANCTIONS CHECK
Perform real-time sanctions check on all
key data sources SAM, OIG etc.,
LICENSE VERIFICATION
Automated State and Federal licensure
verification
INTELLIGENT ROUTING
Intelligent routing of cases based on
automated cred validation

10. 10
90%
50%
100%
80%
Smart Credentialing can be a ‘game-changer’ for both Providers and Payers!
KEY OUTCOMES
Reduction in manual Primary Source
Verification, Sanctions check and licensure
verification
Increase in Credentialing team productivity
No credential files to print for committee
review
Near Real-time credentialing and re-
credentialing

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Virtusa’s PLM Solution Provides End-to-end Lifecycle Management
SOLUTION COMPONENTS
PROVIDER LIFECYCLE MANAGEMENT
EXTERNAL INTEGRATIONS INTERNAL INTEGRATIONS
Provider Directories
Contract Management
Roster Management
EMR | Clinical Systems
Claims System(s)
Document Repository
REPORTING & MDM
RECRUITING
Identifying and Recruiting
Providers to join a
hospital system or health
plan network
CREDENTIALING
Validating the Provider
Credentials before they
can join the Hospital
system
SERVICING
Managing the ongoing
maintenance necessary to
effectively service
existing providers
ON-BOARDING
Complete they setup in
internal systems as well
as external facing
integrations with Payers
Provider Master Database (PMD)
| Operational Reporting

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PROVIDER LIFECYCLE MANAGEMENT –
A Unified Solution with differentiated
capabilities that modernizes all aspects of your
complex Provider relationships
ROBOTIC
AUTOMATION
PRE-BUILT
INTEGRATIONS
INTERACTIVE
DASHBOARDS &
REPORTING
AUTOMATED
ROSTER FILE
MANAGEMENT
INTELLIGENT
WORKFLOW
MANAGEMENT
DIGITAL
ENABLEMENT

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Providing a superior User Experience is a critical driver for adoption
USER EXPERIENCE
User Centered
Design
Effective Customized
Dashboard
Core tasks to
manage at a glance
Increased User
Adoption
Relevant info at the
relevant time
Omni Channel
Approach

14. 14
We’re Successfully Transforming Provider Operations Across Key Customers
PLM SUCCESS STORIES
BENEFITS
Implemented PLM’s Roster File
processing module for Humana to
streamline their Intake and
Credentialing process and reduce
manual data/entry and
validations.
Implementing our PLM solution as
a product to streamline and
automate the existing manual
process for PLM.
Led the assessment, solutioning
and roadmap for Centene’s PLM,
from prospecting through to
configuration, for 21 different
states. Currently leading the
multi-year implementation efforts
> Complete review and analysis of
existing Provider workflows
> Defined ROI metrics
> Transformed Roster Processing
> Targeted Credentialing in next
phase
> Deploy RPA for Cred and MHS
> Standardize the roster template
across all Hospitals and Doctors
> Reduce SLA from 25 to less than 5
days
> Increase Provider SAT and data
integrity
> Identified Current State challenges
> Defined future state capabilities
> Developed future state solution
architecture
> Developed ROI model necessary to
secure multi-year funding
TOP 10 NATIONAL
HEALTH PLAN
TOP 5 NATIONAL
HEALTH PLAN
TOP REGIONAL
HEALTH PLAN

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Contact Our Experts:
Frank Bianchi | fbianchi@virtusa.com
Dan DiSantis | ddisantis@virtusa.com
Baskar Mohan | BMohan@virtusa.com
Robert Mills| rmills@virtusa.com
John Engerholm | jengerholm@virtusa.com
www.virtusa.com