Medicare Medicaid Service Line—Solutions Consulting

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Healthcare
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Medicare Medicaid Service Line

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Transformation Starts Here

ENSURING SUCCESS IN A COMPETITIVE AND REGULATED MARKET

Cognizant works with leading Medicare and Medicaid healthcare organizations to reduce costs, expand with new services and improve member care.

THE DIGITAL MANDATE FOR HEALTH PLANS

High growth projections make Medicare, Medicaid and Dual-Eligibles very attractive markets:

Cognizant’s end‑to‑end product and specialized service for Medicare and Medicaid lowers operating costs, improves delivery and quality of care, increases top‑line revenue growth and ensures regulation compliance.

We provide Medicare services that span more than 30% of all Medicare Advantage and Part D Members:

Original Medicare Plans
Medicare Advantage Plans (HMO, PPO, FFS & SNPs)
Prescription Drug Plans
Medicare Supplement (MediGap) Plans

We support payers who provide Medicaid services spanning more than 60% of all Managed Medicaid Lives:

Managed Medicaid Programs
Children’s Health Insurance Program (CHIP)
Dual-Eligibles (including Integrated Duals)
Managed Long Term Services & Supports (MLTSS, LTSS and LTC)

SOLUTIONS

TARGET THE BEST MARKETS

Cognizant's TriZetto Healthcare Products offer an array of solutions that enable healthcare organizations to target specific Medicare, Medicaid and Dual-Eligibles focus areas for enhanced business results with reduced costs and improved member care.

STRATEGIZE
CAPITALIZE ON PROGRAM EXPANSION
- Medicare and Medicaid Expansion: Assist customers with new business acquisition and expansion with scalable options
- Medicare Advantage Enrollment and Financial Reconciliation: Ensure accuracy through reconciliation of enrollment and CMS payment reports
- Advisory and Implementation Services:
  
  Integrated Care for Dual-Eligibles Market: Enable integrated dual demonstrations and reduce time to market with our end‑to‑end products, implementation services and repeatable frameworks
  
  Long-term care and Long-term services and supports (LTC & LTSS): Enable successful implementation of LTC/MLTSS programs by managed care organizations (MCO)
- My Government Health Plan: A multi service “stack” solution for Medicare Advantage plans
ENGAGE
CONNECT WITH DIGITAL CONSUMERS
- Member Retention and Recapture: A solution to assure member retention and recapture strategies using healthEngage
- Member Outreach and Care Coordination
- Provider Engagement Strategies and Credentialing
- Population Health Management: A comprehensive PHM solution to improve care and health outcomes for chronic conditions, especially for duals
- Digital Works and Analytics
- HEDIS Reporting for Medicare/Medicaid: An NCQA Certified HEDIS Solution that helps you plan, monitor, intervene and improve HEDIS scores and quality of care
OPERATIONALIZE
DIGITAL-READY INDUSTRY PROCESSES
- Enrollment Administration: Accurate MA/Part D enrollment, including data collection, maintenance and submission to CMS
- Financial Reconciliation: Automated reconciliation of CMS Medicare payments
- Risk Adjustment and Revenue Optimization: Helps identify and predict gaps in HCC coding to plug revenue leakage
- Encounters and PDE Management: Manage, audit and attest the completeness and accuracy of Encounter and PDE data
- Pharmacy Oversight and PDE Data Management: Automates the PDE submission process and workflow with CMS and PBM
- MSP Validation and Premium Restoration
- Industry & Platform Solutions: Enrollment, billing, claims, customer service, care management and credentialing
COMPLY
SUPERIOR CARE, COMPLETE COMPLIANCE
- Star Rating Performance Enhancement: Earn higher incentive payments and attract more members with integrated consulting, robust analytics, automated campaigns and nurse‑based intervention
- Compliance Oversight and Management: Ensure audit readiness and compliance with CMS requirements
- Broker/Agent Management
- Appeals and Grievances (A&G)
- Medicaid Regulation: Impact assessment and remediation
PRODUCTS AND PLATFORMS
SCALE UP FOR PERFORMANCE
Our products and platforms enable efficient claims processing, automated enrollment, encounter management, quality reporting and member-centric care management.