Case study

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.

Automation streamlines processing and insights

Nine months after its initial launch, ClaimsXM, powered by the Facets core administrative platform and hosted in the Microsoft AzureTM Government Cloud, has increased the auto-adjudication rate to over 94% and has led to the majority of claims being submitted correctly the first time. Ultimately, this allows providers to be paid in a timelier manner, expanding access to care for members and minimizing administrative costs by avoiding reworking claims. The success of this project has led to Signature Performance’s government client receiving national recognition and several industry awards, including the G2X 2022 Disruptive Tech and Change Agent Awards, the FedHealthIT Innovation Award 2022 and the 2022 Cognizant Healthcare Excellence Award.

7 million+

claims adjudicated in the in the first year of operation

98%

accuracy rate for claims processing

30%+

increase in claims auto-adjudication within the first nine months after its initial launch