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Problem
Manual Workflows, Mounting Compliance Risk
A long-standing health insurer committed to improving the well-being of its community, faced mounting challenges in managing its provider termination process. The workflow was tangled in manual steps, spreadsheets, and email threads, with each termination involving dozens—or even hundreds—of provider-location-plan-service combinations.
Teams struggled with limited visibility into task ownership, relied on shared mailboxes for coordination, and faced compliance risks due to fragmented notifications and inconsistent record tracking. Even with early automation efforts using tools like PowerAutomate, the process remained labor-intensive.
Staff had to manually update dozens of fields per provider and trigger reassignment workflows by hand, creating operational drag and increasing the likelihood of errors. Without centralized oversight or scalable automation, the process couldn’t meet the demands of a growing provider network.
Q1
Solution
SmartSuite Rebuilds the Backbone of Termination Ops
A complete rebuild of the Regional Healthcare Organizations termination and operational workflow architecture within SmartSuite.
Changes Included:
- Relational Data Modeling
SmartSuite was used to model a healthcare-grade schema: Providers, Locations, Services, Contracts, Plan Lines, Members, Claims—all linked with logical rules that replicated the Healthcare Organizations enterprise data logic. - Dynamic Plan Line Generation
Instead of manually picking from 100+ entries, users could select any “Dr. Rick at a regional Hospital” and SmartSuite automatically found all the applicable plan lines to terminate. - Smart Dashboards & Visual Workflows
Dashboards showed clear, color-coded status across departments. This helped managers track who had what, how long it had been assigned, and which teams were behind. - Inbox-to-Task Email Automation
New Outlook email triggers automatically created SmartSuite records from shared mailboxes—eliminating inbox clutter and ensuring accountability. - Smart Docs & PDF Templates
Termination forms could now be exported as branded PDFs and emailed to stakeholders—improving communication and removing the need to navigate SmartSuite for simple updates. - Built-In Documentation
Every SmartSuite formula included inline comments, and field-level help text explained configuration logic—making onboarding easier and reducing future maintenance risks.
The architecture allows enablement of the next phase of scaling across departments.
Q2
Result
From Bottleneck to Blueprint: SmartSuite at Scale
SmartSuite is now transforming operations across the Healthcare Organization.
- 75% process time savings for provider terminations
- 30 full-time equivalents (FTEs) saved in care management workflows
- Increased leadership visibility via executive dashboards and real-time performance metrics
The implementation has inspired additional departments (network, credentialing, contracting) to request SmartSuite workflows, creating a flywheel of adoption.
SmartSuite is now positioned as a core workflow engine at the organization and future integrations with systems like eVIPs will only deepen its value.
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