Delegated Rosters

The challenge

In delegated provider models, independent practice associations (IPAs) are responsible for maintaining provider credentialing and rosters. For a dual special needs health plan (D-SNP), however, files were being delivered in inconsistent formats, with missing or unreliable identifiers.

The health plan’s system of record for provider data, the platform*, lacked a standardized, governed mechanism to ingest delegated rosters at scale.

As a result:

• Provider data governance was fragmented
• Roster errors propagated downstream before detection
• Claims process instability increased
• Manual remediation became the norm

The solution

DocMe360 partnered with the health plan and the platform to design and implement a delegated roster ingestion capability embedded directly into the platform itself.

The solution included:

• Standardized roster intake requirements for IPAs
• Pre-ingestion validation and error isolation
• Defined ownership and governance workflows
• Audit-ready traceability aligned to daily operations

This transformed roster ingestion from an ad hoc process into a controlled, enterprise-grade capability within the platform.

Results

• Improved claims stability through cleaner provider data
• Reduced manual remediation and downstream exceptions
• Greater confidence in delegated provider data
• Scalable, repeatable intake process aligned to governance standards

Impact

What began as a client-specific remediation evolved into a platform-level enhancement, positioning it as a true backbone for delegated provider operations. By closing a critical gap in delegated roster management, the health plan reduced operational risk while strengthening provider data integrity across the enterprise.

*system name intentionally anonymized