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OFFERINGS

Clinical Services

    Our clinical services practice helps payers and providers better manage their medical management services and reduce the operational cost of providing wellness and care management services With licensed clinicians and URAC certified centers, our Global Delivery model enables solutions that include:
  • Pre-Authorization
  • Utilization Management
  • Nurse Helpline (Voice /Web)
  • Member Outreach
  • Wellness programs
  • Case Management
  • Disease Management

Membership Services

    Our focus is on creating customer-centric and transformational operating models for Healthcare companies to better manage their membership services. Our solutions increase quality, improve turnaround time, and drive productivity. Services include:
  • Enrollment Processing
  • Benefit Coding & Testing
  • Agent Licensing
  • Premium Billing & Reconciliation
  • Process Optimization
  • Cycle time reduction through the use of G-COV

Claims & Provider Services

    Claims and Provider Services include:
  • Front End Processing
  • Claims Processing
  • Adjustments/COB Processing
  • Provider Data Management
  • Credentialing / Re-credentialing
  • Provider Contract Management
  • Network Management
  • Fraud and Abuse Management
  • Clinical Review of Claims
  • Medical Bill Review
  • Pre-Authorization
  • ICD-10 Business Services
  • Billing
  • Accounts Receivable
  • Payment Posting & Reconciliation
  • Credit Balance & Refunds
  • Tele-Radiology

Pharmacy & Intermediaries

    Services for Pharmacies & Intermediaries include:
  • Claims Processing
  • Enrollment / Eligibility
  • Provider / Payer Enrollment
  • EDI Claims Support
  • Pharmacy Benefit Coding

Resources

Improving compliance and reducing penalties to create an efficient claims process
Learn how Cognizant helped a leading national health insurer reduce its pend rate from 13.8% to 4%, resulting in improved claim finalization rates and driving more on-time payments to providers.
Beating industry benchmarks through analytics and process re-engineering
Learn how Cognizant identified process rationalization opportunities to reengineer the workflow of a leading health information and research company from a case-based approach to an activity-based approach.