The challenge
Cox HealthPlans wanted to enhance its operations by maximizing the capabilities of its TriZetto® QNXT™ core administration system from Cognizant. The major health insurance company faced a challenge in managing claims workflows: It didn’t have an effective workflow strategy. Claims received had to be manually forwarded to the company’s claims department through its various processing departments. Without either one accountable person or a tracking process in place, the company had difficulty tracking the status of claims, which at times got lost. This impacted service levels, as well as member and provider satisfaction—and resulted in costly fines for late payments. To address these issues, the company implemented Cognizant’s QNXT™ Claims Workflow™ application.