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Case study

The challenge

El Paso Health was using manual processes to track, assign, work and monitor operations in three key departments: Health Services, Claims, and Complaints and Appeals. As the regional health plan’s volumes grew, it began searching for an automated solution to streamline these operations. In addition, during the COVID-19 outbreak much of the plan’s workforce transitioned to fully remote work and it had limited means to hire additional associates.  Thus, the ability to track assignments efficiently, handle higher priority items rapidly and route items to appropriate work queues so the person with the right expertise could handle the task right away was crucial.

Our approach

Cognizant’s Healthcare Consulting Practice provided a roadmap for El Paso Health’s operations improvements. It recommended that El Paso Health use QNXT’s automated workflow engines to manage workloads, set priorities and organize queues in each department. El Paso Health has achieved a multitude of operational efficiencies, reduced costs and improved quality with the engines.

El Paso Health has a variety of complex contracts with the state of Texas that require significant maintenance. Claims under these contracts had to be manually calculated and priced. We worked with the plan to implement NetworX Pricer to address those issues. NetworX Pricer has eliminated the manual processing and intervention associated with El Paso Health’s Texas DRG contract reimbursements, including its potential preventable event reductions and complicated direct provider payment reimbursements. NetworX Pricer also has helped El Paso Health reduce its contract configuration time by enabling the plan’s teams to copy rate sheets, make adjustments for new rate sheets and track complex configurations.

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El Paso Health strengthens healthcare delivery

El Paso Health implemented these operational efficiencies during the COVID-19 pandemic and by doing so was able to manage larger transaction volumes without increasing staff levels. The QNXT Workflow engines and NetworX Pricer eliminated pain points, workarounds and manual interventions. The Appeals & Grievances Workflow deployment resulted in 100% automation. The Claims Workflow engine increased auto-adjudication by 8.7% and increased provider satisfaction scores by 4.65%. The UM Workflow enabled El Paso Health to achieve regulatory compliance with Texas Health and Human Services regulators and increase provider satisfaction with utilization and quality management by almost 15% and with network/coordination of care by 20%. Hospital claims auto-adjudication increased by 15% and the overall claims auto-adjudication rate increased by 8.7%.


market share achieved through efficient processes


automation on reimbursements for complex diagnosis-related group (DRG) contract


automation of Appeals & Grievances