The denial pattern you can't explain almost always starts in the provider file
Two live provider agents catch directory and roster errors before they become claim denials, processing 8M+ provider transactions a year.
12 of Top 15
US health plans
3 of Top 5
Blue (BCBS) plans
100M
lives touched across the value chain
Avasant RadarView™
Leader in Healthcare Payer Business Process Transformation
Everest Group PEAK Matrix®
Leader in Healthcare Payer Intelligent Operations
NelsonHall NEAT
Leader in Healthcare Payer Agility & Innovation
Everest Group
Front-runner in the Generative AI Healthcare Payer Market
NelsonHall
Leader in Healthcare Payer Operational Transformation
ISG Provider Lens™
Leader in Payer Transformation on Healthcare Digital Services
Everest Group PEAK Matrix®
Leader in Healthcare Payer Business Process as a Service Solutions (BPaaS)
WHY THIS MATTERS
Provider data errors don't stay in the back office
Several forces are making provider data the most expensive back-office problem most plans still ignore.
Credentialing drag
$2.1B
US health plans spend $2.1B annually on credentialing. NCQA's July 2025 rule just made it harder, compressing initial windows and requiring 30-day ongoing sanctions monitoring for every provider. Most plans aren't ready for that frequency.
SPRYPT, Navigating medical credentialing
Directory accuracy
$25K+
CMS directory inaccuracies carry penalties from $25,000 per violation upward. From 2027, Medicare Advantage plans must submit directory data directly to CMS, making internal compliance public accountability.
CMS Final Rule CMS-4208-F2, 2026
Denial pressure
50%
Missing or inaccurate claim data is the leading cause of denials, cited by 50% of revenue cycle leaders, up four points from 2024. At the center of the issue is provider data quality.
Experian Health 2025 State of Claims Survey
PROVEN OUTCOMES
What live provider agents actually move
Success outcomes from provider operations programs across multiple US health plans.
8M+
provider transactions a year
Provider data transactions processed across 9 health plan clients at 98% accuracy, with 800-plus dedicated associates running add, term, and update workflows.
80%
higher audit productivity
Provider audits moved from manual to fully automated for a regional Blue plan, at 100% audit accuracy across the full provider file.
98%
claims fallout correction accuracy
Provider-side error correction in the PDM workflow clears 95% of fallout cases within 3 business days at 98% accuracy, stopping denials before adjudication.
Network Operations SOlutions
Where provider work runs. The agents are already there.
One operating layer that keeps provider work moving without losing accuracy or control.
Built for NCQA's new credentialing clock
End-to-end credentialing, from initiation through primary source verification, committee preparation, and continuous monitoring. Initial credentialing is completed in fewer than 15 days with more than 99% accuracy across 230,000 files annually.
- Sanctions monitoring every 30 days to meet NCQA 2025 requirements
- Primary source verification through CAQH, NPDB, and OIG
- AI agents streamline roster management
Keeps pace with 3% monthly data drift
Firstsource handles add, term, and update processing, data cleansing, directory maintenance, and claims error correction at 98% accuracy and 95%-plus within turnaround, with the PDM AI agent automating roster ingestion and cascade changes.
- 8M+ transactions a year
- 99.5% claims fallout accuracy
Defensible CMS directory submission
Automated outreach, attestation workflows, and AI-assisted matching keep directories current to No Surprises Act timelines and ready for direct CMS submission from the 2027 plan year.
- NSA 2-business-day update workflows
- Ongoing accuracy scoring
- Delegated roster management
Contracts loaded right, the first time
Decision agents extract provider demographics, validate data, and configure pricing, cutting provider-contract turnaround to under 6 minutes.
- 99.5% contract loading accuracy, all reimbursement types
- 98% LBED timeliness, fee schedule creation and QA
- 90% faster turnaround via Decision Agent
- QNXT, Facets, HealthRules Payer, no migration
Where provider calls trace back to data breaks
Claim status queries, prior auth calls, and directory error complaints are downstream symptoms of upstream data failure. Firstsource integrates contact center operations with process mining to trace call patterns to their root cause in PDM or credentialing, and closes the loop, not just the ticket.
- Up to 35% productivity lift via agentic AI
- Smart Mailbox Copilot: auto-routing and ticket creation
- English and Spanish, three delivery locations
Providers who can't get answers leave the network
Network retention starts with how easy it is to check credentialing status, view a contract, or update information. Firstsource builds self-service across the full lifecycle, reducing inbound volume, accelerating turnaround, and keeping providers active longer.
- Self-service: roster, demographics, attestation
- Proactive expiration outreach before credentials lapse
- Contract and PSV status visible without a call
- Omnichannel: email, phone, and portal
The claims loop closes here
Claims fall out when a provider NPI is missing, network status is stale, or a fee schedule has not loaded. Firstsource closes this at the source, with error correction embedded in the PDM workflow, clearing 95% of cases within 3 business days at 98% accuracy. Process mining fixes root causes, not just individual claims.
- 98% accuracy on fallout corrections
- Automated NPI/Tax ID/location cross-reference
- One workflow: call to correction to PDM update
WHO WE SERVE
Each segment runs on its own operating logic
Each health plan runs under different regulators, margin structures, and operating logic. We build for the segment, not around it.
National plans
Every line. Every state. No simplification.
National plans carry multi-state, multi-line complexity across Medicare, Medicaid, Commercial, and Exchange. Firstsource runs claims, member and provider services, enrollment, and appeals at scale, priced on the outcome.
Blues plans
Modernization that keeps member operations running
Regional and Blues plans face local regulation and the cost of multi-platform administration. Firstsource delivers end-to-end BPaaS transformations, cutting admin spend and tech debt without a production outage.
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Self-funded
Full claims risk demands full precision
Self-funded employers, TPAs, and ASO arrangements carry the full claims risk. Firstsource runs core admin on PMPM pricing, with multi-platform migration experience across QNXT and HealthRules. TPA-licensed in 36 states.
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PROOF OF DELIVERY
Live programs, each proving a key result
90%
faster provider contracts
Decision agents cut provider-contract turnaround to under 6 minutes, keeping networks current without manual bottlenecks.
95%+
PDM within turnaround
Provider add, term, and update work clears at 95%-plus within a 10-business-day turnaround, at 98% accuracy.
>99%
audit accuracy
Automated provider audits run at 100% accuracy, eliminating the manual discrepancies that pend claims.
INSIGHTS
Latest from the Firstsource team
Insights from the field, real operations, real outcomes, and perspectives from the people making it work in live operations.
Case Study
Building a strong foundation for growth: how a leading dental plan transformed operations with strategic partnership
Discover how a leading dental plan partnered with Firstsource to transform operations, reduce costs, improve CSAT, and enable scalable growth through AI and a hybrid delivery model.
CONTACT US
When provider data breaks, claims break with it
Provider data breaks at the handoff between updates and claims. The operation is scoped from where yours is breaking today.
- 2 live provider agents, no platform replacement.
- Priced on accuracy and turnaround compliance, not headcount.
- 8M-plus provider transactions a year across 9 plans.