Business Process Services

Unifying the healthcare ecosystem

A smart partnership ecosystem is essential for payers, providers and pharmacy benefits managers to succeed. We help clients gain a competitive advantage by combining clinical, business and process expertise with intelligent digital platforms to create efficient and agile operations.
Cognizant has deep expertise providing business process transformation and managed services across the healthcare ecosystem. We draw upon decades of transformative industry experience, harnessing automation, AI and advanced analytics to drive unmatched productivity, cost efficiencies and revenue growth.
We help Healthcare companies become intuitive enterprises powered by innovation and a global workforce of healthcare experts and advisors.

Improve member experiences

We’re helping healthcare payers by combining a dynamic workflow, leading-edge technology and a team of talented professionals to achieve optimal member experience at reduced operational costs.

Automate processes and improve efficiency

Our member enrollment, premium billing, reconciliation, and member onboarding services put members are the center, ensuring a seamless experience across their multiple touch points. Our solutions in benefits configuration simplify complex benefit structures, thereby improving efficiency with enhanced quality.

Establishing a single source of truth

Industry leading capabilities from provider credentialing to contract loading and provider data management, our solutions create and sustain accurate provider information. With Cognizant, payors can create comprehensive PDM strategies that address these 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 onetime initiative.

Experience breakthrough improvements

With deep understanding of claims function, our expertise spans across front-end / mailroom operations to claims adjudication, processing appeals and supporting Special Investigation Units (SIU). Our integrated solutions ensure accurate and timely payments, reducing interest payouts and penalties.

Streamline utilization management and optimize care management

Cognizant’s Care Management services can help payors gain access to certified and experienced clinical talent pools globally. Helping clients deliver improved clinical outcomes for over a decade, our delivery teams offer expertise in Utilization Management, Case Management, and population health management.

Intuitive one-stop solution

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 that are designed to improve CSAT & NPS scores.

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Digital revenue cycle management solutions

We offer end-to-end revenue cycle management process for healthcare providers to improve reimbursements rates, identify and arrest revenue leakages and improve patient experience.

Maximize RCM efficiency

Cognizant’s RCM services provide business outcomes across all settings of care for hospitals and practices of various sizes, scope, specialties, and care. From Scheduling/Registration to payment posting, we handle end-to-end revenue cycle management services for Hospital/Health systems and physician practices. We help you maximize efficiency with proprietary RCM workflow technology that digitizes revenue management and improves cash flows.

Simplify patient experience and digitize touchpoints

Our complete suite of patient and member access and engagement includes registration, scheduling, remote patient monitoring, discharge planning, health risk assessments and wellness and lifestyle coaching. Improving these areas allow providers to embrace a digital-first and integrated transformation, providing their patients with fast, easy and safe experiences.

Specialized billing and coding services

Cognizant provides customized coding and charge master services for any size or type of organization from physician practices to hospitals/health systems. We leverage the latest RCM technologies to expedite and automate processes that helps in reduction of errors and higher clean claim submission rates. Discover our fully outsourced mid-cycle RCM services that are highly customized, and designed to scale, as per volume and size.

The right mix of technology and experts

Our Account Receivables service combines skilled collectors and proprietary technology to collect account receivables through all revenue streams – payers or patients. We have established workflows as per payers for timely reimbursements. Multi-channel outreach and financial assistance programs maximize revenue from patient self-pay recovery.

Attorney-led recovery models

Cognizant can help healthcare organizations overcome growing reimbursement complexities and optimize revenues. We identify the proper workers’ compensation and third-party liability carriers. We ensure claims are paid in accordance with the state fee schedule and appeal any claims paid incorrectly. Proprietary systems with decision tree technology regulate workflow guidelines & management.

Solutions to improve provider efficiencies

Our clinical administrative services focuses on improving patient experience and quality of care. Our robust set of services include utilization management, bill review, record retrieval, gaps identification and physician training. We expert resources include 350+ USRNs (Registered Nurses), 700+ Certified specialists helping providers to improve the clinical process efficiencies.

Enhance pharmacy operations

We provide best-in-class services for pharmacy benefit managers with digital definition capabilities and improved automation through advanced technological solutions.

Gain efficiency across claims adminstration

We offer a flexible pharmacy claims processing platform and efficient distribution channel management services for employers and third-party administrators who want to improve processes while controlling drug costs.

Intelligent web tools that reduce configuration timelines

Cognizant’s workflow extracts and consolidates information across all departments of the 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.

Implement centralized frontend mailroom service

Cognizant implements an efficient frontend mailroom by creating a standard data platform for order intake, a centralized workflow for prescription filling center and update, a call center to support mail-order pharmacy services, and contacting doctor's offices to obtain prescription refills or verify missing or illegible information.

Catering to every patient type and drug need

Our service offerings include digital solutions that scan and scrutinize every medicine request and calculate the urgency of the treatment based on a pre-defined triage degree. This is a time-saving and error-reducing workflow. To make the process of order fulfillment faster, our workflow platform accounts for tracking, verification, approvals, follow-ups and on-time delivery.

HEALTHCARE MANAGEMENT

Leadership

Giri Namala

VP, Healthcare Markets

Brent Barber

VP, Healthcare Delivery

Take the first step

Serving customers by looking forward as well as back is a big promise, but the power of today’s new digital capabilities is vast and growing.

Let’s talk about how digital can work for your business.