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Pennsylvania-based Geisinger Health Plan (GHP) wanted to develop new product lines and enlarge its market presence. However, the health plan was struggling with its 20-year-old core administration system, which could not accommodate its business expansion strategy. GHP needed an advanced system technology with integrated functionality to support new and existing lines of business, while meeting all state and federal regulations for commercial and government products. GHP partnered with Cognizant for an automation solution that could help achieve its strategic growth objectives.
The advanced system technology aimed at improving administration cost margins, and enabling the timely set-up of innovative products and third-party administrator groups. They also wanted to eliminate manual processes, support future scalability, and enable rapid configuration and integration of new product offerings with TriZetto Facets, TriZetto® NetworX and TriZetto Elements technology.
We replaced GHP’s existing system with the TriZetto® Facets® core administration platform for more cost-efficient processing. Next, we integrated strategic best-in-class applications, including NetworX Pricer® and TriZetto Elements®, with the core system to further enhance differentiation and competitive advantage. NetworX Pricer administers increasingly complex provider contracts, and TriZetto Elements delivers an integrated Medicare application in compliance with government mandates.
By migrating its business to the new Facets core platform using a phased approach, GHP achieved its system replacement and team adoption on time and within budget. GHP brought in the TriZetto and Cognizant healthcare technology teams to evaluate the processes and recommended adjustments, prior to production one month before each phase went live. This methodology further ensured project success with minimal impact to the plan’s clients and providers.
By leveraging the broad functionality of the Facets core system to meet most of its needs in a single platform, GHP was able to accomplish its strategic goals. The new system better supports compliance and other external market demands, streamlines workflow, increases automation and reduces errors. It also aligns processes and systems with the health plan’s long-term strategic goals, including participation in programs such as Health Information Exchanges. GHP can now effectively address its enterprise process and system integration requirements to include care management, marketing/sales support and patient delivery. Operational and automation efficiencies could enable the health plan to repurpose 20 staff members to higher value activities.
increase in auto-adjudication rates
on-time submissions to Centers for Medicare & Medicaid Services
provider payment accuracy achieved
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