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Case Study | Regional Blues Plan

A HealthHelp client was experiencing provider dissatisfaction with their UM process along with a high denial rate.  Savings was coming from denials and not care focused on improved outcomes.  We worked in partnership to implement our collaborative and proactive provider outreach model along with our clinically superior tech.

Denials reduced by 50%  |  Savings and Provider Satisfaction Increase

Commercial Program

(Cardiology, MKS, Sleep, Surgical)

Initial Challenge

  • High prior-auth denial rate
  • Provider dissatisfaction
  • Savings through denial

HealthHelp Solution

  • Proactive outreach to providers
  • Supported providers with clinical education by top-tier specialist
  • Providers chose modification or withdrawl, reducing denials

Outcomes

  • Net direct savings ROI: 4.9
  • Annualized savings rate of $8M
  • Reduced denials/abrasion
  • Provider NPS: 60

About Availity

Availity empowers payers and providers to deliver transformative patient experiences by enabling the seamless exchange of clinical, administrative, and financial information. As the nation’s largest real-time health information network, Availity develops intelligent, automated, and interoperable solutions that foster collaboration and shared value across the healthcare ecosystem. With connections to over 95% of payers, more than 3 million providers, and over 2,000 trading partners, Availity provides mission-critical connectivity to drive the future of healthcare innovation. For more information visit www.availity.com.

About WNS-HealthHelp

HealthHelp, a unit within WNS, is a trusted healthcare technology platform for health plans’ clinical programs for over 25 years. Our unified suite of Advanced AI powered technology platform-based solutions simplifies medical complexity and workforce challenges, and enhances provider relations and member journeys (i.e., customer experiences). Our uniquely designed UM and clinical solutions were developed to fit into health plans’ existing clinical programs to advance outcomes and success. We work in partnership to understand health plan commercial and Medicare clinical programs, and determine where our solutions can advance outcomes and lower cost. There is no one size fits all, and we know how to expediently deliver the best tailored solution for a specific health plan’s needs.

About WNS

WNS (Holdings) Limited (NYSE: WNS) is a digital-led business transformation and services company. WNS combines deep domain expertise with talent, technology, and AI to co-create innovative solutions for over 600 clients across various industries. WNS delivers an entire spectrum of solutions including industry-specific offerings, customer experience services, finance and accounting, human resources, procurement, and research and analytics to re-imagine the digital future of businesses. As of December 31, 2024, WNS had 63,390 professionals across 66 delivery centers worldwide including facilities in Canada, China, Costa Rica, India, Malaysia, the Philippines, Poland, Romania, South Africa, Sri Lanka, Turkey, the United Kingdom, and the United States.
For more information, visit www.wns.com.

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