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Case study

The challenge

A major U.S.-based health plan wanted to expand its dental business while reducing operational complexity. But legacy processing platforms limited its ability to take action. To meet its goals, the health plan needed to phase out legacy IT systems, eliminate dual maintenance of group and membership data, and consolidate resources and skill sets.

The plan engaged Cognizant to migrate its dental product administration onto a single integrated platform that supports business expansion as well as new product development.

Our approach   

We helped the health plan migrate its dental product administration from multiple legacy mainframe platforms to the TriZetto® Facets® core administration platform. With this in place, the plan implemented the TriZetto® Facets® Dental module and migrated its dental offerings to the same platform. Next, the plan implemented TriZetto® Facets® Real-Time Claim Processing Services with its integrated dental clearinghouse functionality to provide near-immediate responses to eligible claims. The combination of solutions and Facets integration enables the health plan to integrate membership set up across products and plan options while generating a single bill and consolidating electronic remittances. Collocating dental and medical memberships on one system helps the plan increase efficiency and accuracy across operations and processes.

One Platform for Medical and Dental Helps Achieve Business Objectives

The supplemental TriZetto Facets applications helped the health plan successfully consolidate multiple legacy dental applications on one integrated platform. This integrated platform streamlines dental processes, improving performance as well as provider and member experiences. The health plan also continues to increase its savings opportunities as the portal expands self-service options across broker, group, member and provider constituencies. Offering subscribers a one-stop shop for dental and medical plans, along with a single dashboard view of their benefits, positions the health plan to grow its dental business.

20%

increase in first-pass rate on dental claims

99%

production load success rates during member migration to the Facets platform