Integration without making the business stop.
World’s largest healthcare revenue cycle services provider
After an acquisition, the world’s largest healthcare revenue cycle services provider had to combine two businesses. Its clients could not see any interruption. Workstreams ran in parallel, with cutovers sequenced around business continuity.
The world’s largest healthcare revenue cycle services provider had to integrate an acquired business while its clients’ claims, denials and prior authorizations kept moving. An outage would not stay internal: it would delay cash for the providers it serves. The margin for error is already thin. Experian Health’s State of Claims 2026 survey, reported by HFMA, finds that 40% of providers say 10% or more of claims are denied, and that most providers recover only 50%–70% of revenue from denied claims. The 2023 CAQH Index reports that providers spend on average 11 minutes on an electronic prior authorization and 16 minutes via a portal. The integration had to protect that work, not interrupt it.
- 01 / FOUNDATION
Set ownership before the first cutover.
Each workstream was given a named owner, success measures and readiness criteria. Decision rights for go and no-go calls were agreed up front, together with the service levels that had to hold throughout the program.
- 02 / EXECUTION
Integrate through governed connections.
Systems were connected through governed interfaces rather than one-off scripts. Data flows were mapped and validated before cutover, and every cutover carried a rollback plan. Workstreams ran in parallel, with cutovers sequenced around business continuity.
- 03 / INTELLIGENCE
Watch the exceptions.
Monitoring compared service volumes before and after each cutover. Agents flagged mismatches and routed them to the workstream owner with context; people made the release and rollback decisions.
- Map
Systems, interfaces and data flows are inventoried for each workstream.
- Validate
Mappings are checked against sample records before anything changes in production.
- Rehearse
Each cutover and its rollback are run in a test environment.
- Decide
The workstream owner makes the go or no-go call against the readiness criteria, in a shared program view.
- Cut over
The change goes live in a window sequenced around client service.
- Verify
Volumes and exceptions are monitored until the workstream is signed off.
The measure of success is that clients never notice the integration. The combined business inherits a documented, connected estate with named owners, which becomes the foundation for agentic work in claims and prior authorizations.
The disciplines behind the outcome.
- 01 / DELIVERY AREA
Integration
- 02 / DELIVERY AREA
Cutover coordination
Apply the same discipline to agentic work: explicit system ownership, readiness criteria, controlled release and recovery.
Outperformed the industry benchmark.
The integration outperformed this baseline for claims, denials and prior authorizations.
- 10%+ · of claims denied, according to 40% of providers.
- Most providers recover only 50%–70% of revenue from denied claims.
- 53% of providers say “services not covered” is in their top three reasons for denials.
- Providers spend, on average, 11 minutes conducting a prior authorization electronically and 16 minutes via a portal.
- The medical industry spent 30% more, or $1.3 billion, on prior authorizations than in the previous year.
Experian Health, “State of Claims 2026: An uphill battle to reduce denials,” HFMA · CAQH, 2023 CAQH Index