Success Story

The client is a US-based self-funded healthcare services platform operating as an insurance company, benefit program manager, and data aggregator across major provider networks. Their integrated marketplace connects third-party administrations (TPAs), health plan managers, solutions partners, and consultants streamlining plan administration and network access provider collaboration at scale.​

The client sought to eliminate critical bottlenecks across its paid claims reconciliation and Pay-for-Performance (P4P) disbursement operations. Key business challenges included:

• Optimizing and streamlining the paid claims reconciliation process to improve operational efficiency and financial accuracy.
• Enhancing visibility into paid claims data to reduce operational overhead and enable data-driven decision-making through a scalable solution.
• Accelerating the disbursement cycle for Pay-for-Performance (P4P) payments, applicable exclusively to paid claims, to minimize delays and ensure contractual compliance.

Cybage implemented a streamlined and scalable Pay-for-Performance (P4P) onboarding and integration ecosystem. The solution ensured faster go-live readiness, operational reliability, and seamless provider network collaboration through:

• Stakeholder engagement and onboarding communication across the implementation lifecycle.
• Secure and reliable technical connectivity between client systems and platform environments.
• Comprehensive integration testing and validation to ensure deployment readiness and minimize operational risks.
• Proactive post-production monitoring and rapid issue resolution to ensure uninterrupted business operations.

• Expanded network integration coverage by onboarding 33 third-party administrations (TPAs), strengthening ecosystem connectivity and operational scalability.
• Automated and optimized 73% of the end-to-end Pay-for-Performance (P4P) reconciliation workflow, significantly improving operational efficiency.
• Enabled accurate and timely disbursement of $1.5M–$2M across the provider network, improving financial transparency and trust.
• Reduced the credit cycle from 90 days to 45 days, accelerating cash flow and improving financial operations across the network.