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Improve plan accuracy and quality

Improve plan accuracy and quality

50% reduction
in go-live timeline for healthcare benefits plans.

A new era for pharmacies and pharmacy benefit managers is here and it’s far from business as usual.

As competition encroaches on the traditional healthcare sector and online giants, Cognizant helps retail, specialty and mail order pharmacies and pharmacy benefit managers (PBMs) rethink their business models. We can help you deliver targeted, personalized services in innovative ways, to gain a new competitive advantage in a changed world.

Our capabilities

  • Regulatory compliance

    Simplifying a complex regulatory environment

    Cognizant helps healthcare organizations evaluate the impact of regulatory requirements and implement solutions that help ensure compliance. Our services include:

    • ICD-10
    • Medicare Part D compliance
    • NCPDP D.0 compliance
    • Controlled substance dispensing
    • Patient compliance
  • Health intelligence and analytics

    Driving better health outcomes

    The ability to access and leverage data is changing the way business decisions are made, with rich insights enabling evidence-based decision-making and proactive planning. Cognizant provides expertise on data collection across a wide range of attributes affecting pharmacy and PBM businesses, helping them make well-informed decisions in:

    • Analytics strategy
    • Process innovations
  • Investigative services

    From detection to prevention

    Enabling organizations to identify and resolve intentional and unintentional errors or verify the absence of both is critical. With significant capital lost to fraud and abuse each year, investigation and recovery efforts are key to an organization’s overall financial health.
  • Operational improvement

    Invest in the digital future

    We help healthcare organizations drive cost reduction and revenue enhancement through improved efficiency, effectiveness and process transformation by offering:

    • Best-in-class services (claims, enrollment and medical management)
    • Requirements definition
    • Product evaluation and selection
    • Operational readiness
  • Consumerism

    Empower consumers with digital tools

    New consumer-focused operating models in healthcare demand a shift in thinking, requiring many companies to go from a B2B to a B2C focus. Cognizant helps healthcare organizations manage the patient and member experience with solutions that drive engagement and help build effective strategies for member identification and retention. Our services span these areas:

    • Customer engagement
    • Customer experience
    • Customer retention
  • Implementation services

    Deliver digital health services at scale

    We offer complete project and IT implementation and support services, including:

    • Legacy systems modernization
    • Administrative, claims management, clinical and electronic health record implementations
    • Custom development and maintenance
    • Systems integration and program management
    • ERP and CRM systems
    • Data warehouses
    • E-health, self-service applications and portal development

Featured work


Higher healthcare plan volumes, lower performance guarantee payouts

  • Expand

    The challenge

    Each year, U.S. health insurance companies provision millions of dollars in anticipation of health plan inaccuracies and legal penalties. To deliver accurate health benefits and minimize legal payouts, insurers must ensure their systems are ready for business at the start of the new year.  

    A leading U.S.-based retail pharmacy and pharmacy benefits manager faced high payouts every year due to erroneous claims. The company wanted to raise the bar on the customer experience with improved patient-centric care and more accurate claims administration.

    Our approach

    Cognizant modernized the company’s benefit plan rollouts using BenefitSERV, our Intelligent Product for platform-based benefits configuration and automated validation. We improved the customer experience with a three-pronged strategy: pharma experts who focus on the end user; accurate coding of benefits plans; and end-to-end automation of the validation process.

    More flexible, accurate and competitive health plans

    With Cognizant’s end-to-end approach to quality assurance (QA) the company achieves both a many-fold increase in plan volumes and 100 percent compliance with its “plan active by date” targets. Our solution improves plan accuracy to 99.5 percent, helping the company reap significant savings in payouts—and increase its bottom line. Better plan accuracy also translates to member satisfaction.


    reduction in go-live timeline for healthcare benefits plans


    reduction in QA costs

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.