Whitepaper · Health Plans, TPAs & Health Services · Informatica Customer 360
Member, provider and payer, matched before the claim.
Provider and practice masters on NPI, TIN and location; member identity and attribution; employer groups and plans; and drug product masters.
01 · Executive summary
The short version
- PDI delivers 24 health plans, tpas & health services use cases on Informatica Customer 360 with its accelerators. The use cases are drawn from 8 anonymized account profiles.
- Each use case arrives pre-mapped: the 18 entities it can land on, the 18 source-system families it draws from, and the match and data-quality rules for those entities.
- Design decisions are captured in adaptive-card workshops: 132 cards across 10 data-model workshops, so every answer becomes a configuration input.
- The entry point is a $50,000 fixed-fee MDM implementation for any two source systems. Informatica licensing is procured separately.
02 · The master-data problem
Where the records disagree.
Plans, administrators and health-services firms reconcile three populations continuously: the members they cover, the providers who treat them, and the employers or payers who fund the plan. Claims, directories and attribution all fail quietly when any one of those identities is duplicated.
The accelerator lands these use cases on Customer 360 for Healthcare: HCP, HCO, Practitioner Role, Member, Payer, Plan and Location, with broker and employer-group masters modeled alongside. Public sources, including the NPPES provider registry and X12 834 enrollment and 837 claim transactions, are catalogued as source systems.
03 · What is prepackaged for this industry
The accelerator, before day one.
Data model in play
- Member11 use cases
- HCO10 use cases
- Payer10 use cases
- Contract10 use cases
- Plan10 use cases
- HCP8 use cases
- Practitioner Role8 use cases
- Person8 use cases
- Organization8 use cases
- Location6 use cases
- +8 moreAgreement, Medicinal Product, Packaged Medicinal Product, Pharmaceutical Product, Category, Item, Product, Legal Entity
Source-to-target mappings
- NPPES NPI RegistryColumn-level mappings with page-level evidence
- X12 837 claimsElement-level mappings, confirmed per implementation
- Salesforce Sales and Service CloudColumn-level mappings with page-level evidence
- X12 834 enrollmentElement-level mappings, confirmed per implementation
- HL7 FHIR R4Element-level mappings, confirmed per implementation
- CMS CCLF claims filesElement-level mappings, confirmed per implementation
- 12 enterprise system familiesContract / bid / co-op pricing systems, CRM, Credentialing platform / CAQH ProView, Health-plan core admin, ERP item / customer / vendor master, CDP / marketing automation, Claims platform / TPA feeds, Licensing / provisioning / billing…. Mapped at attribute-family level; column names confirmed from the data dictionary.
Rules and workshops
- 40 match rulesIn the library for the entity types in play, ranked from exact keys to fuzzy name-and-address matching.
- 35 standardization rulesAcross 23 attribute families: names, addresses, phones, emails, identifiers and more.
- 132 adaptive cards10 data-model workshops, from party sub-types to stewardship.
- Member and provider card set12 decision areas: member identifiers, standardization, match posture, survivorship, trust ranking, household, provider anchor, hierarchy depth, steward capacity, cross-agency policy, purpose taxonomy, borderline handling. 7 member and provider source structures are mapped to the model.
04 · Use-case accelerator map
23 patterns, each with a landing.
Every pattern below is delivered on Informatica Customer 360 with PDI's accelerators. Patterns are anonymized from account profiles; a count such as 3× means the pattern recurs across profiles. Source systems are shown as system families.
| Use case pattern | Typical source systems | Lands on |
|---|---|---|
| Member 3602× | X12 834 enrollment, Health-plan core admin, CDP / marketing automation, CRM | Payer, Person, Organization, Member, Contract |
| Broker & Employer Group MDM | CRM, Health-plan core admin, Licensing / provisioning / billing | Payer, Hierarchy relationships, Member, Contract, Plan |
| Claim Data Quality | X12 837 claims, Claims platform / TPA feeds, ERP item / customer / vendor master | Data-quality rules |
| Claimant / Injured Worker MDM | EHR / EMR / PM | Member, Person |
| Consumer & Prescriber 360 | E-commerce / web accounts, CDP / marketing automation, NPPES NPI Registry, Salesforce Sales and Service Cloud | Person, Organization, HCP, HCO, Practitioner Role |
| Drug / Product (NDC) MDM | Market data | Medicinal Product, Packaged Medicinal Product, Pharmaceutical Product, Category, Item |
| Employer Client & Plan MDM | CRM, Licensing / provisioning / billing, Contract / bid / co-op pricing systems | Payer, Member, Contract, Plan |
| Employer Group & Plan MDM | CRM | Payer, Member, Contract, Plan |
| Health System Client Hierarchy MDM | Salesforce Sales and Service Cloud, Regulatory / registry feeds | Hierarchy relationships, Legal Entity, HCO, Location |
| Member / Patient 360 | X12 834 enrollment, X12 837 claims, Claims platform / TPA feeds | Member, Payer, Person, Contract, Plan |
| Patient / Member 360 & payer attribution | X12 837 claims, CMS CCLF claims files, HL7 FHIR R4 | Person, Member, Payer, Organization, Contract |
| Payer & Adjuster Client MDM | CRM | Payer, Organization, Person, Member, Contract |
| Payer Client & Plan MDM | CRM, X12 837 claims, Claims platform / TPA feeds, Licensing / provisioning / billing | Payer, Member, Contract, Plan |
| Payer Contract & Program MDM | Contract / bid / co-op pricing systems, ERP item / customer / vendor master | Payer, Member, Contract, Plan, Agreement |
| Pharma Client & Brand Account MDM | Salesforce Sales and Service Cloud, ERP item / customer / vendor master | Organization, Person |
| Pharmacy & Location MDM | Market data, Contract / bid / co-op pricing systems | Location, HCO |
| Provider & Facility MDM (network + pricing) | Contract / bid / co-op pricing systems, NPPES NPI Registry, Credentialing platform / CAQH ProView | HCP, HCO, Practitioner Role, Location |
| Provider & Practice MDM (NPI/TIN/location) | NPPES NPI Registry, HL7 FHIR R4, EHR / EMR / PM, Salesforce Sales and Service Cloud | HCP, HCO, Practitioner Role, Location |
| Provider / HCP MDM (NPI, specialty, licensure, affiliation) | NPPES NPI Registry, Regulatory / registry feeds | HCP, HCO, Practitioner Role |
| Provider / Surgeon & Facility MDM | NPPES NPI Registry, Credentialing platform / CAQH ProView, Contract / bid / co-op pricing systems | HCP, HCO, Practitioner Role, Location |
| Provider MDM | NPPES NPI Registry | HCP, HCO, Practitioner Role |
| Provider MDM & Directory Accuracy | Health-plan core admin, Credentialing platform / CAQH ProView, Contract / bid / co-op pricing systems | HCP, HCO, Practitioner Role |
| Provider Network MDM (PT clinics, NPI/TIN/location) | Credentialing platform / CAQH ProView, Contract / bid / co-op pricing systems, NPPES NPI Registry | Location, HCP, HCO, Practitioner Role, Organization |
05 · How it deploys
Five steps, each already built.
The accelerator replaces blank-page design with decisions, a drawn model and pre-built mappings.
- Decide
Adaptive-card workshops capture the design. 10 data-model workshops, 132 cards. Each card asks one decision with two to four mutually exclusive options, and each answer is logged as a configuration input.
- Model
The health plans, tpas & health services model is already drawn: 18 entities, with their relationships and hierarchies, selected for the use cases in this paper.
- Map
The two sources arrive pre-mapped. 364 column-level mappings cover NPPES, MedPro, GLEIF, SAP, Salesforce and GS1, and 60 source-system families are catalogued in all.
- Match
Match, merge and quality rules start from a library: 20 match models with 65 rules, and 35 standardization rules across 23 attribute families.
- Prove
Tenant checks and acceptance. 80 documentation discrepancies are confirmed on the tenant before configuration is generated, and the acceptance measures agreed in discovery are tested.
This Customer 360 industry entry offer is distinct from the separately scoped Informatica MDM MVP.
06 · The two-source entry point
How a $50K MVP lands here.
A fixed-fee MDM implementation for two source systems. The model, the mappings, the match and data-quality rules and the workshop cards exist before the engagement starts.
- Starting pattern
- Provider and practice master (NPI, TIN and location)
- Source system 1
- NPPES public provider registry
- Source system 2
- Credentialing or provider-network system
- Lands on
- HCP, HCO, Practitioner Role and Location from Customer 360 for Healthcare
- What it proves
- A provider directory keyed to NPI, with practice locations and roles reconciled against the plan's own network file.
The $50,000 covers PDI professional services only. Informatica licensing is procured separately through Informatica. Additional sources, domains or scope changes after configuration begins are estimated separately. The example sources are illustrative; any two source systems qualify, and the pair is confirmed in discovery.
07 · Confirmed in discovery
What each engagement settles first.
- The two source systems. 12 enterprise system families appear in this industry. Their column names are confirmed from the customer's data dictionary before mappings are finalized.
- The tenant. 80 documentation discrepancies across the model are confirmed on the customer's tenant before configuration is generated, including field-group internal IDs that are read from tenant metadata.
- Package order. Industry packages are imported before any customization, because importing an industry package overwrites existing Customer 360 customization.
- Acceptance. Acceptance measures are agreed in discovery, before the fee is committed.
08 · Method
How this paper was built.
The use-case map, data model, mappings and rules come from PDI's accelerator, built on Informatica's published Customer 360 and Industry 360 documentation (April and July 2026 releases) and extended for each industry. Use cases are anonymized from 124 account profiles; no account is named. Adaptive-card counts come from PDI's Customer 360 data-model workshop set. The paper states no project durations or outcome figures; those are set as acceptance measures in discovery.