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Harness Medicare Markets

EFFICIENTLY EXPAND YOUR MEDICARE BUSINESS

TriZetto Healthcare Products provides an extensive portfolio of capabilities to meet the specific needs of your Medicare Advantage business.

SOLUTIONS THAT GROW MEDICARE MARKETS


Our experience and capabilities will help you effectively address your Medicare administration needs, revenue management and data submission so you can respond quickly to evolving mandates and regulatory requirements.

The number of people receiving Medicare benefits is projected to rise nearly 60% by 2030. For health plans serving this market, long-term success demands increased system efficiencies to support this rapid growth. Medicare market success also requires tools that enable continued compliance with changes in Medicare reporting rules, complex Centers for Medicare and Medicaid Services (CMS) regulations and the Medical Loss Ratio (MLR) requirement.

With more than 30% of all Medicare Advantage and Part D lives processed on our core systems, the Cognizant line of TriZetto Healthcare Products provides an extensive portfolio of capabilities to meet the specific needs of your business. This comprehensive and highly effective combination of advanced technology and services offerings can help you lower administrative costs, increase speed to market and decrease total cost of ownership. Other capabilities work to:

  • Automatically enroll new members
  • Generate, edit and reconcile required Risk Adjustment Payment System (RAPS) and encounter data submissions
  • Accurately reconcile Medicare members
  • Enhance risk score accuracy to receive proper reimbursement
  • Identify where members have Hierarchical Condition Categories (HCCs)
  • Utilize analytics to improve your Five-Star Quality Rating
  • Coordinate and improve care for Medicare members
  • Manage new reimbursement and care models

PRODUCTS

Core Administration

Increases payer efficiency, improves productivity, reduces costs and positions your business for growth.

Care Management

Connects care managers to members and providers while reducing costs, personalizing interventions and improving care quality.

TriZetto® TranZform®

Enables shared decision-making, communication and collaboration as a multi channel, modularized solution.

Provider Network Management

Automates pricing scenarios to provide the best value to payers, providers and patients.

Quality Management

Enables payer/provider collaboration to reduce costs and drive overall quality improvement.

Trading Partner Management

Manages EDI trading partners with one cost-effective, cloud-enabled technology service.

Portal Technology

Automates transaction processing and information exchange between payer organizations and their external constituents.

Optimization Tools

Automate and simplify operational tasks associated with our core healthcare technology solutions, Facets and QNXT.

TriZetto Elements®

Extend the functionality of your core system by providing critical capabilities from enrollment through risk adjustment, to efficiently administer government solutions.

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HEALTHCARE VISION BLOG

GET THE RECOGNITION YOU DESERVE

HEALTHCARE EXCELLENCE AWARDS

Congratulations to finalists and winners: Cognizant honors clients that use our technology solutions to build new best practices or discover new ways to address changing business models. Find out this year’s finalists and winners and how the healthcare excellence awards program can get your organization the recognition it deserves.

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CONTACT US

At Cognizant, we are here to provide you with more information about our TriZetto Healthcare Products software and service solutions and answer any questions you may have.

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