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Claims Workflow Automation Streamlines Processes to Enhance Service and Reduce Penalties

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.

Our Approach

Our QNXT™ Claims Workflow™ helps Cox HealthPlans prioritize claims, replacing cumbersome manual reports and spreadsheets with real-time management views. Using the system, claims supervisors can now locate a claim and continuously track its status. In addition, the application’s alert feature notifies senior management when claims are approaching interest and penalty status, so they may be resolved within the 45-day guideline.

QNXT Claims Workflow Improves Productivity

QNXT™ Claims Workflow™ reduces costs, enhances member and provider satisfaction, and improves productivity for Cox HealthPlans by automating its claims tracking and workload management processes. In addition, the efficiency gained enables the health plan to absorb analyst attrition without replacing staff.

22% increase

in processing productivity

9% decrease

in penalty payments 2017 YTD compared to 2018 YTD