A major U.S. healthcare organization with more than one million members in its government programs had difficulty modernizing the systems and capabilities required to comply with the emerging regulatory requirements of the Centers for Medicare and Medicaid Services. Its systems were outdated and expensive. Low automation rates, extensive manual processes and non-standardized data structures resulted in inadequate claims processing turnaround times and claims pricing inaccuracies. Antiquated customer service tools and minimal interactive voice response capabilities resulted in poor user experiences that hurt the brand and its standing with CMS.
The payer turned to Cognizant's healthcare technology experts for a comprehensive yet cost-effective solution that would solve its immediate need for a modern, end-to-end solution and provide a foundation for thriving under value-based care.