COGNIZANT CONSULTING
Helping organizations engage people and uncover insight from data to shape the products, services and experiences they offer
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  • Working to reshape business models, modernize products and enhance customer experiences to drive growth.
  • Reinventing and managing your most essential business processes with new ways of working.
  • Simplifying, modernizing and securing the IT infrastructure and applications that are the backbone of your business.
COGNIZANT CONSULTING
Helping organizations engage people and uncover insight from data to shape the products, services and experiences they offer
Learn More

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Helping your organization succeed in a competitive and highly regulated environment.

OVERVIEW

High growth projections make Medicare, Medicaid and Dual-Eligibles very attractive markets. With a diverse portfolio of services, Cognizant's Medicare Medicaid Service Line caters to customer needs through solutions aimed at succeeding in Medicare, Medicaid and Duals markets. We offer end‑to‑end product and specialized service offerings for all Medicare and Medicaid needs to lower the operating costs, improve delivery and quality of care, increase top‑line revenue with strong emphasis on regulation compliance.

With the 2014 acquisition of the TriZetto Corporation, we are uniquely positioned to deliver end-to-end solutions that allow organizations to improve operational efficiency, drive innovation and embrace next generation delivery models made possible by digital technologies.

 

Supporting 117 payers who provide Medicare services comprising over 30% of all Medicare Advantage & Part D Members

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

 

Supporting 93 payers who provide Medicaid services comprising over 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)

CAPABILITIES

Every Health Plan is looking at ways to enter into Medicare, Medicaid and the Duals markets. Payers seek to enter markets without impacting the existing lines of business. We offer an array of solutions that enable healthcare organizations to target specific Medicare, Medicaid and Duals focus areas for enhanced business results with reduced costs and improved member care.

Strategize

  • Medicare and Medicaid Expansion: Assist customers with new business acquisition and expansion with scalable options
  • Medicare Advantage Enrollment & 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 (LTC & LTSS): Enable successful implementation of LTC/MLTSS programs by MCOs
  • My Government Health Plan: A multi‑service “stack” solution for Medicare Advantage plans

Engage

  • Member Retention and Recapture: Assure member retention and recapture strategies using healthEngage
  • Member Outreach & Care Coordination
  • Provider Engagement Strategies & Credentialing
  • Population Health Management: A comprehensive PHM solution to improve care and health outcomes for chronic conditions, especially for duals
  • Digital Works & 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

  • Enrollment Administration: Accurate MA/Part D enrollment, including data collection, maintenance and submission to CMS
  • Financial Reconciliation: Automated reconciliation of CMS Medicare payment
  • Risk Adjustment & Revenue Optimization: Helps identify and predict gaps in HCC coding to plug revenue leakage
  • Encounters & PDE Management: Manage, audit and attest the completeness and accuracy of Encounter & PDE data
  • Pharmacy Oversight and PDE Data Management: Automates PDE submission process and workflow with CMS and PBM
  • MSP Validation & Premium restoration
  • Business Process Services: Enrollment, Billing, Claims, Customer service, Care Management and Credentialing 

Comply

  • 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 & Management: Ensure audit readiness and compliance with CMS requirements
  • Broker/Agent Management
  • Appeals & Grievances (A&G)
  • Medicaid Regulation: Impact Assessment & Remediation

Products & Platforms:

Our comprehensive Medicare and Medicaid products and platforms compliments the above service offerings to enable your organization to lead the market with efficient claims processing, automated enrollment, encounter management, quality reporting and member-centric care management.

  • Onvida: Omnichannel contact engagement as a service
  • EvolveSPM: Sales channel management
  • StarSERV: Improve star ratings through insight‑driven decision making and quality improvement interventions
  • ClaimSphere HEDIS: NCQA‑certified HEDIS® solution for healthcare payers

RESOURCES

Getting Ahead in Medicare, Medicaid & Duals Market

Cognizant’s Medicare Medicaid Service Line (MMSL) helps healthcare organizations plan and achieve successful growth.

Cognizant Medicare & Medicaid Solutions

Leading the industry with advanced Medicare Advantage and Medicaid capabilities.

Cognizant’s Medicare Medicaid Service Line | MMSL Solutions | Cognizant Technology Solutions