The challenge
Signature Performance worked with its government client for more than 18 years. As its customer faced care access challenges, Signature Performance recognized that its claims system had to be modernized to ensure beneficiaries would have timely access to healthcare. Areas to address included the speed and accuracy of claims processing, reporting methodologies, compliance, security and administrative support. In the existing legacy claims system, only about 60% of claims were auto-adjudicated. That meant many of the client’s staff and contractors had to manually enter data that led to data quality issues, reworking of claims, a high volume of calls from providers and patients for assistance and increased administrative costs for the government client and ultimately, US taxpayers. Time- and labor-intensive backend processes also limited flexibility in allocating human resources to other high-value and patient-facing work.
Our approach
Signature Performance’s commitment to reducing healthcare administrative costs inspired it to create a robust managed services offering, so it brought in Cognizant TriZetto’s Healthcare Product Consulting team to design a solution to meet the unique needs of its government client, including robust security and compliance for member data. Cognizant’s TriZetto Facets claims administration platform was leveraged as the core of the new service offering, called ClaimsXM.
The flexibility of the Facets platform was critical as minimal documentation existed for the legacy system’s requirements and dependencies. Signature Performance’s development teams worked with Cognizant consultants to conduct a wide-range analysis and uncover business rules. It became clear during this process that even the most complex business rules could easily be configured in Facets to meet requirements. The resulting system is also highly scalable so Signature Performance can leverage ClaimsXM for future growth. Facets’ data-driven approach streamlines administrative tasks and has eliminated administrative backlogs, eased provider frustrations and reduced other manual challenges often associated with claims administration.
