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TRANSFORMATION STARTS HERE

Succeed in a regulated market

Succeed in a regulated market

30%
The percentage of all Medicare Advantage and Part D members that our services span, including original Medicare, Medicare Advantage, prescription drug and MediGap plans.

Healthcare organizations turn to digital technologies to ensure success and provide services in a competitive and regulated market.

Projections for high growth make Medicare, Medicaid and Dual Eligibles extremely attractive markets. Organizations can increase their chances of success with Cognizant’s end‑to‑end products and specialized services for Medicare and Medicaid, which lower operating costs, improve delivery and quality of care, increase top‑line revenue growth and ensure regulation compliance. Cognizant works with leading Medicare and Medicaid healthcare organizations to help them achieve the highest performance.

HEALTHCARE ECOSYSTEM

Targeted solutions

Applying digital solutions to healthcare delivery questions. 

TriZetto® Healthcare Products

Cognizant’s TriZetto Healthcare Products help you drive administrative efficiency, improve quality of care, and improve member and patient experiences.

Additional capabilities

  • EXPAND

    CAPITALIZE ON PROGRAM EXPANSION

    • Medicare and Medicaid expansion—Assist customers with new business acquisition and expansion with scalable options.
    • Medicare Advantage enrollment and financial reconciliation—Ensure accuracy through reconciliation of enrollment and CMS payment reports.
    • Advisory and implementation services
      • Integrated care for Dual Eligibles market—Enable integrated dual demonstrations and reduce time to market with our end-to-end products, implementation services and repeatable frameworks.
      • Long-term care and long-term services and supports (LTC & LTSS)—Enable successful implementation of LTC/MLTSS programs by managed care organizations (MCOs).
    • My government health plan—A multi service “stack” solution for Medicare Advantage plans.
  • ENGAGE

    CONNECT WITH DIGITAL CONSUMERS

    • Member retention and recapture—A solution to assure member retention and recapture strategies using healthEngage
    • Member outreach and care coordination
    • Provider engagement strategies and credentialing
    • Population health management—A comprehensive PHM solution to improve care and health outcomes for chronic conditions, especially for duals
    • Digital works and analytics
    • HEDIS reporting for Medicare/Medicaid—An NCQA Certified HEDIS Solution that helps you plan, monitor, intervene and improve HEDIS scores and quality of care
  • OPERATIONALIZE

    LAUNCH DIGITAL-READY PROCESSES

    • Enrollment administration—Accurate MA/Part D enrollment, including data collection, maintenance and submission to CMS
    • Financial reconciliation—Automated reconciliation of CMS Medicare payments
    • Risk adjustment and revenue optimization—Helps identify and predict gaps in HCC coding to plug revenue leakage
    • Encounters and PDE management—Manage, audit and attest the completeness and accuracy of Encounter and PDE data
    • Pharmacy oversight and PDE data management—Automates the PDE submission process and workflow with CMS and PBM
    • MSP validation and premium restoration
    • Industry & platform solutions—Enrollment, billing, claims, customer service, care management and credentialing
  • COMPLY

    OFFER SUPERIOR CARE, COMPLETE COMPLIANCE

    • Star rating performance enhancement—Earn higher incentive payments and attract more members with integrated consulting, robust analytics, automated campaigns and nurse based intervention.
    • Compliance oversight and management—Ensure audit readiness and compliance with CMS requirements.
    • Broker/agent management
    • Appeals and grievances (A&G)
    • Medicaid regulation—Perform impact assessment and remediation.
  • DEPLOY

    SCALE UP FOR PERFORMANCE

    Our products and platforms enable efficient claims processing, automated enrollment, encounter management, quality reporting and member-centric care management.

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.