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HEALTHCARE

Automation Reduces Manual Claims Submission by 59%

The Challenge

The Medi-Cal business of California-based Kern Health Systems (KHS) faced the daunting challenge of handling a substantial cumulative increase in claim volume—around one million submissions each year. The health plan also wanted a solution that would help contracts comply with regulatory requirements and enable alternative payment methodologies in conjunction with its existing core TriZetto® QNXT™ system. After reviewing several providers’ offerings, KHS selected Cognizant’s TriZetto® NetworX suite of software solutions.

Our Approach

The health plan saw significant improvements within three months of implementing our healthcare technology solution, which included business, operations and scalability objectives. Our suite helps KHS increase first-pass rate, reduce or eliminate manual interventions, decrease contract configuration time, handle most complex pricing scenarios, and support ongoing regulatory changes and Medi-Cal requirements. KHS also uses the NetworX Pricer® application as a central pricing engine for multisource claim systems because it interfaces with TriZetto® Facets® and TriZetto QNXT, as well as with non-TriZetto core systems.

NetworX Boosts Productivity and Yields High Return on Investment

With NetworX, KHS can now create automated, complex contracts by accessing a library of more than 350 calculations and 125 qualifiers—enabling faster, more accurate and efficient administration. Continued utilization of our NetworX suite will provide KHS a greater return on investment, as its provider contract administration and analysis processes gain further efficiencies and cost savings while supporting ongoing regulatory compliance.

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76%

decrease in new contract configuration time

75%–83%

overall increase in auto-adjudication

50%

decrease in end-to-end contract set-up time

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