CORE TRANSACTION PROCESSING

Cognizant’s outcome-driven BPaaS delivery model supports payers in the Medicare Advantage, Managed Medicaid, Medicare Part D, Duals, PDP, Medicare Supplement, Commercial, Individual and Small Group markets with core transaction processing for:

• Configuration
• Enrollment/Reconciliation
• Fulfillment
• Billing & Financial Reporting
• Claims/Providers
• Encounters/RAPS
• Provider & Member Call Center
• Mail Room and Preprocessing Services
• Analytics, Reporting
• Appeals & Grievances

PLATFORM STRATEGY OVER PRODUCT STRATEGY

Core IT modernization is achieved with access to the industry’s leading payer platform and ecosystem, which provides payers with a platform strategy rather than a product strategy. The high cost and stress of system changes and upgrades are eliminated by including maintenance and new releases within the Per Member, Per Month (PMPM) fee structure. With the Cognizant Healthcare BPaaS solution, payers will always have current technology with built‑in scalability.

• Rules-driven Enrollment Engine
• Core Platform
• HIPAA Gateway
• Encounter Data Manager
• Claims Data Manager
• Financial Reconciliation Manager
• Optum Clinical Editing
• IVR & Integrated CRM
• Fulfillment tool
• Imaging Application (web-based)

INCREASE REVENUE WITH BETTER COMPLIANCE

A top notch compliance program can do more than just help you avoid trouble; a properly administered compliance program can increase plan revenue by boosting Star Ratings, HEDIS scores and other measures of success, drive new business models and contribute to membership growth.

Cognizant’s Healthcare BPaaS team includes an Independent Compliance and Audit Services Department, governed by a Compliance Committee and Chief Compliance Officer, dedicated to keeping you in front of regulatory and operational requirements. Services include:

• Compliance Oversight
• Dedicated Performance Reporting (Operations)
• Dedicated Audit Function -  Regulatory, Delegation, State and CMS Audit Assistance
• Security Requirements
• FWA & HIPAA Compliance
• Policies/Procedures