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Case study

The challenge

Kern Health Systems (KHS) is a managed care health plan serving more than 250,000 MediCal recipients throughout Kern County, California. One year after its initial implementation of the TriZetto® QNXT™ core administration system from Cognizant went live, KHS was ready to upgrade and take advantage of valuable compliance and automation enhancements. At the same time, KHS was also upgrading to a newer version of SQL, thereby adding to the upgrade complexity.

Finally, because the KHS team needed to complete the upgrade while supporting other key initiatives, they established an aggressive seven-week timeframe for the project—significantly less than the four-to-six-month process required for previous system upgrades.

Our approach

Cognizant Systems Implementation (SI) provided KHS with the crucial support needed to upgrade all custom DLL processes to meet their objectives. KHS technical and business resources worked closely with the Cognizant SI team to develop a well-articulated strategy for the DLL components. The result was a highly successful upgrade that was completed on time and with no disruption to operations. The upgrade had progressed so smoothly that executive management was unaware it had even taken place.

Saving money from the start

System enhancements began delivering value almost immediately, improving automation and supporting regulatory compliance for the health plan’s MediCal business. KHS was also able to fully retire its previous legacy system, saving significant expense and allowing processing personnel to be re-assigned to more complex auditing responsibilities.

83%

auto-adjudication achieved

75%

percentage decrease in time needed to upgrade the new TriZetto system

3%

increase in the auto-adjudication rate