How a provider-to-payer database got rebuilt around how plans actually work.

A flat plan list rebuilt into a five-tier hierarchy. The Aequalis Payer Insights Platform wired in for public LOBs. A national claims clearinghouse partnership for Commercial LOB. The offshore Data Operations team repositioned to high-judgment work.

How the 3Pillars team learned what was actually inside the provider database.

The marketplace had been attributing providers to “plans” for over a decade, but the definition of “plan” had drifted. Sometimes it meant the parent payer. Sometimes a state subsidiary. Sometimes a specific Medicare Advantage product. Sometimes a benefits package inside that product. The diagnostic mapped how the database had grown organically, where the hierarchy had collapsed, and what providers and patients were actually seeing as a result.

• A documented map of every attribution path in the current database
• A proposed five-tier hierarchy (parent → subsidiary → LOB → benefits plan → network) with a migration plan
• A quantified view of the commercial-LOB gap and a partnership thesis for closing it
• A workstream-by-workstream build plan with the offshore Data Operations team scoped in as a collaborator on the future state

How the database got rebuilt and the integration layer went live.

Weeks 4-10 ran two parallel tracks. The schematic redesign, owned by engineering and data leadership. And the integration layer, built in partnership with Product, Operations, and the offshore Data Operations team. The Aequalis Payer Insights Platform plugged in as the source-of-truth feed for public LOBs. The clearinghouse partnership closed the commercial gap. Each piece had to land without breaking the live marketplace.

• Schematic redesign and migration. Built the five-tier hierarchy. Migrated historical provider attributions into the new structure. Reconciled old-to-new against the live database with zero record loss.
• Aequalis Payer Insights Platform integration. Wired in the Platform’s rolled-up repository of every MA, Medicaid, and individual exchange plan in the country, organized by parent company and state.
• Claims clearinghouse partnership. Stood up a data-sharing relationship with a national claims clearinghouse to close the commercial-LOB visibility gap. Refreshed monthly.
• Refresh cadence design. Built quarterly refresh workflows aligned to how each LOB actually updates: MA at start of plan year, ACA at start of plan year, Medicaid quarterly, commercial monthly off the clearinghouse feed.

• Offshore team re-scoping. The offshore Data Operations team shifted from manual maintenance to reviewing refresh outputs, handling exceptions, and owning the quarterly QA pass. High-judgment work the agents could not do.
• Reconciliation and audit logging. Every migration commit and every refresh cycle produces a reconciliation report and an audit trail engineering and data leadership sign off on.
• Transition plan. Roles, refresh cadence, escalation paths, and the Week 11-12+ handoff sequence specified before the build wraps. Future-state opportunities (intake agent, live anomaly maintenance) scoped for when the underlying database is in place.

What gets built and how it runs.

Four workflows delivered in this engagement. Each carries a human-in-the-loop checkpoint before output drives action. Nothing writes to the production database without a person signing off.

• AI-powered new-provider intake. Normalize incoming provider contracts against the five-tier hierarchy. Cross-reference Aequalis and the clearinghouse feed. Flag gaps and errors before records reach the data lake.
• Live anomaly and hierarchy maintenance. Continuously scan for hierarchy drift, orphaned records, duplicate plan entries, and provider-plan attributions that do not reconcile across sources.

How the work flows across the people who run it.

Pick a persona in the left nav to see how the system changes that seat.

What the team was left with.

The system runs on natural cadences tied to how the underlying payer market actually updates. The offshore Data Operations team remains a core part of the operating model. The database workflow and rules do the high-volume normalization, gap detection, and refresh staging. The team does the 1-off judgment work, exception handling, and final commits.

• New product surfaces using the five-tier hierarchy (e.g., patient-facing plan-match explanations)
• Additional clearinghouse partnerships for redundancy and coverage depth in commercial
• Tighter feedback loop from booking-completion data back to attribution confidence scoring

• AI-powered new-provider intake. Normalize incoming provider contracts against the five-tier hierarchy. Cross-reference Aequalis and the clearinghouse feed. Flag gaps and errors before records reach the data lake. Route exceptions to the offshore team for high-judgment review.
• Live anomaly and hierarchy maintenance. Continuously scan for hierarchy drift, orphaned records, duplicate plan entries, and provider-plan attributions that do not reconcile across sources.
• Deeper claims integration. Move from monthly clearinghouse refresh toward near-real-time commercial-LOB signal as claims pipelines mature.
• Real-time benefit interpretation. Beyond plan-level attribution, surface benefit-level expectations (copays, prior-auth flags) at the moment of booking.
• Provider-onboarding chatbot. A conversational front door for the intake workflow that handles routine provider questions and escalates complex cases to ops.
• Patient-facing plan match assistant. Help patients confirm their specific benefits plan before booking, reducing the “I thought I was in-network” complaint volume.