use case

Provider Onboarding & Contract Compliance Automation

Healthcare Insurance / Managed Care

National Health Insurer managing a network of 250K+ physicians, clinics, and facilities

Provider Contracting, Onboarding, and Compliance

Business Challenge

The provider onboarding process in healthcare involves collecting and validating dozens of data points and compliance attestations before a provider can participate in the network.

Each new contract submission includes multiple unstructured artifacts — applications, W-9s, credentialing forms, service grids, and legal agreements — which vary across states, specialties, and product lines.

Contract administration teams were facing several challenges:

  • Manual review of lengthy contracts and addenda for state-specific clauses (e.g., timely filing limits, termination terms, amendment windows).
  • Inconsistent document packages — missing provider information, outdated reimbursement tables, or incomplete signatures.
  • Fragmented workflow between legal, credentialing, and network management teams, delaying onboarding and increasing compliance risk.
  • Growing audit pressure from regulators and Content Management System for accuracy and completeness of provider records.

BizAI automates the intake, analysis, and validation of all provider onboarding and contracting documents.

Solution: BizAI for Provider Onboarding

Using its Applied GenAI Process Automation framework, BizAI is able to apply the payer’s contract templates, state-specific policies, and internal workflows — ensuring a fully governed, audit-ready process without training on customer data or retaining any provider information.

BizAI outputs structured data to CRM, CLM, and credentialing platforms. By integrating with several systems of record, BizAI enables automated workflow triggers such as record creation, data population, and exception routing.

Representative BizAI Actions

Identify and separate contract types (Physician, Facility, Ancillary), amendments, reimbursement tables, and credentialing attachments.

Break combined submissions into discrete components (e.g., contract, signature pages, product participation lists).

Capture critical data points from each section, including:
  • Provider identifiers: NPI, EIN/Tax ID, specialty, DBA, addresses, contact details.
  • Contract metadata: effective date, term, termination notice period, recoupment timeframe, modification notice days.
  • Reimbursement details: CPT/HCPCS codes, percentage of fee schedule, anesthesia conversion factors, carve-outs, payment method.
  • Compliance elements: Medicare Advantage provisions, Practitioner
  • Assessment Form references, Table 2988 inclusion for lab/pathology.

Validate signatures, confirm contract negotiator names, ensure product participation lists are complete, and cross-check provider details against master data systems.

Assess compliance with state and federal onboarding requirements (timely filing, notice periods, amendment rules) and flag exceptions for review.

Integration & Workflow

Standardization Benefit

By digitizing and automating contract interpretation, BizAI establishes a single source of truth for provider contracts. It eliminates variations in how different teams interpret or key terms — creating a standardized, repeatable onboarding process that meets regulatory and operational compliance.

Business Impact

>90% faster onboarding for standard provider agreements.

95%+ data extraction accuracy across all contract types.

Reduction in compliance exceptions through consistent detection of state-specific clauses.

Improved transparency and audit readiness for CMS and state reviews.

Significant labor savings across legal, credentialing, and contracting teams.

Key Takeaway

Fisent BizAI transforms the complex, manual process of provider onboarding into a streamlined, compliant, and fully auditable digital workflow — ensuring that providers are contracted accurately, faster, and in alignment with regulatory obligations.

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