We help healthcare clients gain a competitive advantage by combining clinical, business and process expertise with intelligent digital platforms to create efficient and agile healthcare operations.
Modern AI-integrated healthcare operations
The playbook for growth is being rewritten. We believe the future belongs to the modern enterprise that embraces AI-integrated business operations—a business that can anticipate and act instantly to boldly seize opportunities amid rapid change.
Innovative partnerships are essential for payers, providers and pharmacy benefits managers to succeed in the competitive healthcare field. We help clients rethink how they create value, innovate and grow by combining business and process expertise in the medical field with intelligent digital platforms to optimize business operations.
MetroHealth and Cognizant partnership in healthcare
MetroHealth’s investments in Cognizant Revenue Cycle Management are driving positive results increasing productivity by 8% in the last year and average daily collections by 25%. The services are built around a proprietary Unified Single Platform (USP), a performance improvement engine and a cloud-based technology platform that continuously deploys automation and innovation to improve quality and financial outcomes. The solution also includes an ARM tool to prevent claim denials on the front end by identifying the root causes of initial claim rejections, avoidable and non-avoidable. The tool can categorize the denials down to the department level, so we can identify trends and use that information to educate and train our staff. Since implementation, denials have decreased by 30%, which translates into $13M in additional revenue.
MetroHealth and Cognizant have a long-standing strong partnership and we continue to work together to reduce denials/accounts receivable and increase cash collections.
Cognizant leverages deep knowledge and expertise to provide business process transformation and services management across the healthcare ecosystem. We harness automation, AI and advanced analytics to give you an intuitive edge. We help Healthcare companies become modern enterprises powered by innovation and a global workforce of healthcare experts and advisors—leading to unmatched productivity, cost efficiencies and revenue growth.
Rising above uncertainty
The ability to strategically reduce costs and invest in new revenue streams is extremely valuable in volatile times.
The implementation of modern operations enables businesses to act with insight and speed—predicting trends, identifying new growth areas and balancing efficiency with innovation.
By modernizing business operations, your organization can anticipate the steps needed to accelerate growth and scale.
Our member enrollment, premium billing, reconciliation, and onboarding services put members at the center, ensuring a seamless experience across their multiple touch points. Our solutions in benefits configuration simplify complex structures and improve efficiency.
Provider data management (PDM)
Industry leading capabilities, from provider credentialing to contract loading and provider data management, our solutions ensure data accuracy. With Cognizant, payers can create comprehensive PDM strategies that focus on four components: single source of truth, data governance, bidirectional integration, and end-to-end platform. We help you structure your processes knowing that PDM is a journey, rather than a one-time initiative.
Claims administration
With deep understanding of claims processing—from front-end operations, claims adjudication and appeals to supporting Special Investigation Units (SIU). Our integrated solutions ensure accurate and timely payments, reducing interest payouts and penalties.
Care management services
Cognizant’s care management services can help payers gain access to certified and experienced talent pools globally. Our delivery teams offer expertise in utilization management, case management, and population health management—helping clients deliver improved clinical outcomes.
Contact center management
Cognizant’s contact center services provide payers with digital transformation solutions that improve member and provider experience. Our services support members and providers with omni-channel contact services designed to improve customer satisfaction (CSAT) and NPS scores.
Cognizant’s RCM gives an intuitive edge to the healthcare industry. From scheduling and registration to payment posting, we handle end-to-end revenue cycle management services for hospitals and physician practices. With proprietary RCM workflow technology, we help you maximize efficiency and improves cash flow with digitized management.
Our complete suite of patient access and engagement includes registration, scheduling, remote patient monitoring, discharge planning, health risk assessments, and wellness and lifestyle coaching. Improving these areas enables providers to embrace a digital-first, intuitive operating model—leading to fast, easy and safe experiences for their patients.
Middle office RCM
Cognizant provides customized coding and charge master services for any size or type of organization, from physician practices to hospitals. We leverage the latest RCM technologies to expedite and automate processes that help reduce errors and increase claim submission rates. Our fully outsourced mid-cycle RCM services will help you scale fast.
Back office RCM
Our account receivables service combines skilled professionals and proprietary technology to resolve accounts through all revenue streams. Established workflows, multi-channel outreach and financial assistance programs maximize revenue and recovery.
Complex claims
Cognizant can help healthcare organizations overcome growing reimbursement complexities and optimize revenue. With expertise and innovative technology, we identify the proper workers’ compensation and third-party liability carriers to ensure claims are paid in accordance with state regulations.
Clinical administration services
Our clinical administrative services focus on improving patient experience and quality of care. You’ll gain a competitive edge with our robust set of services—utilization management, bill review, record retrieval, gaps identification and physician training. Our resources include 350+ USRNs (registered nurses) and 700+ certified specialists.
We offer a flexible pharmacy claims processing platform along with efficient distribution management services for employers and third-party administrators—enabling them to improve processes while controlling prescription costs.
Benefits configuration
Cognizant’s workflow extracts and consolidates information across all departments of the pharmacy benefit managers (PBM), providing plan sponsors with a 360° patient view that enhances critical health and financial decision-making resulting in best outcomes. We provide Day 1 assurance of correct adjudication outcomes, along with complete and accurate eligibility, prior authorization, accumulator and claim history data.
Frontend mailroom services
Cognizant enables modern operations by leveraging a data platform for order intake, a centralized workflow for prescription filling, a call center to support mail-order pharmacy services, and access to physicians’ offices to obtain prescription refills or to verify information.
Mail order processing
Our services include intuitive digital tools to analyze medication requests and calculate the urgency of the treatment—reducing errors and improving efficiency. To speed up order fulfillment, our workflow platform accounts for tracking, verification, approvals, follow-ups and on-time delivery.
Major US healthcare organization leverages intelligent process automation to streamline operations—enhancing member experiences, improving efficiency and reducing costs.
A reimagined customer service-driven strategy enables Siemens Healthineers to streamline operations—leading to 30% reduction in licensure costs and 100% SLA adherence.
A leading U.S. revenue cycle management (RCM) service provider turned to Cognizant to help streamline its benefits eligibility verification process for healthcare providers.
A major health plan transforms its operations with a world-class automation platform that processes claims faster, allowing it to focus on product development and customer experience.
A healthcare organization with more than one million members gains a competitive edge with a cost-effective strategy that simplified operations, increased pricing accuracy and improved the customer experience.
Critical components of an intelligent automation strategy
Digitizing a process doesn’t need to be complicated. We help organizations maximize their efficiency as they undertake process changes to streamline their operations.
How intelligent automation tackles the US opioid crisis
View this infographic to see how Intelligent Automation tackles the US opioid crisis and its effects upon societies and organizations for automating opioid lock-in administration. Find out how combating the opioid crisis through intelligent automation connects payers, government, pharmacy and members, and see the promising outcomes from this program.
A Leader in Clinical and Care Management (CCM) Operations
Cognizant’s diverse in-house medical talent pool, robust suite of services, flexible BPaaS for care coordination and focus on quality improvement services helped cagtapult us into the leaders category in the Everest Group’s Clinical and Care Management Operations Services PEAK® Matrix 2023.
Cognizant named a Leader in Everest Group’s Revenue Cycle Management (RCM) PEAK Matrix
Cognizant was singled out as one of few providers able to deliver the full RCM suite as a result of our deep technical prowess, broad healthcare expertise, robust partner ecosystem and clearinghouse capabilities.
Cognizant named a Leader on Everest Group's RCM Platform Providers PEAK Matrix® Assessment 2022
We were chosen for our healthcare domain expertise and end-to-end platform featuring a deep portfolio of revenue cycle management solutions such as pre-claim, patient access, pre-billing, claims, account resolution, and financial management.
Cognizant named a Leader in Everest Group’s PEAK Matrix® for CXM Services for Healthcare 2022
We emerged as a Leader in this first-time report due to our strong domain presence in healthcare, robust digital-first offerings, and competent global delivery network for servicing payers and providers.
Cognizant named a leader in healthcare payer operations
Everest Group cites our strength in vision and strategy, scope of services such as BPaaS, focused investments in areas including automation and advanced analytics as well as our diversified delivery presence as key factors for our leadership position.
Cognizant named as a Leader on Everest Group’s Revenue Cycle Management Operations PEAK Matrix® Assessment 2022
We once again achieved the highest rating and differentiated ourselves with our end-to-end capabilities in the RCM value chain and our strong analytical and automation solutions for healthcare providers.
Cognizant named a leader in Intelligent Automation in Healthcare—Solutions PEAK Matrix® Assessment 2022
Everest Group cites several differentiators, including Cognizant’s investment in innovation as well as creating a vision and strategy for clients that help them accelerate their digital journey and get business value faster.
Cognizant named a leader in healthcare payer BPS 2021
NelsonHall recognizes Cognizant for our ability to help clients deliver outcomes both today and while preparing for the future. Also, our investment in government programs—BPaaS models—lowers costs and empowers digital transformation.
IDC recognizes Cognizant for its on-demand data access capabilities
IDC recognizes Cognizant’s strategic approach and investment, core experience, comprehensive solutions and SaaS deliver when naming us a vendor to watch in enabling customer-360 data platform for healthcare payers.
Cognizant named an Innovator in the RCM Business Process Transformation 2021 RadarView™
The report provides an analysis of service provider capabilities in technology, domain expertise, and delivery-related capabilities to assist healthcare enterprises in identifying strategic partners for RCM transformation.
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