Revenue Cycle Management Solutions

Build an efficient, reliable revenue cycle

Cognizant’s revenue cycle management (RCM) solutions improve operations, ensure compliance and prevent resource shortfalls. With decades of experience, we help providers focus on patient experiences and achieve better financial outcomes.

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<h3>Experience the breadth of Cognizant RCM  </h3>

Streamlining payer-provider transactions

4.4 billion

annual payer-provider transactions

450+ hospitals and health systems served

450+

hospital and health system clients

875,000

healthcare providers supported

650+

EMR integrations

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Why Cognizant

End-to-end RCM solutions

<h5>Filter by provider type</h5>

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Services and products

Select filter option, All topics, Hospitals and health systems, Ambulatory care organizations

Patient access services

Cognizant’s patient access services address staffing resource deficiencies and use technology to drive convenient and hassle-free front-end interactions. Healthcare organizations partner with Cognizant to simplify the patient experience, digitize touchpoints and increase patient financial clearance.

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{"0":"Hospitals and health systems"}

Eligibility enrollment services

We leverage cutting-edge technology and experienced staff to pinpoint patient accounts with the highest potential for successful enrollment in Medicaid, Medicare and charity programs. Cognizant’s outcome-based solution portfolio includes comprehensive screenings, financial counseling and application support, enabling our clients to provide necessary coverage to high volumes of patients, reducing patient bad debt and self-pay balances.

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{"0":"Hospitals and health systems"}

Coding services

Cognizant’s coding and coding audit services ensure compliance standards are always met with high accuracy and timely turnaround. We provide customized coding services for hospital systems and physician practices delivered by a team of credentialed coders with an average of 10 years of experience.

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{"0":"Ambulatory care organizations","1":"Hospitals and health systems"}

Charge description master management (CDM) services

Cognizant helps providers overcome chargemaster challenges with comprehensive line-by-line reviews and clear guidance on necessary modifications to ensure compliance and accuracy. Once any required updates are identified, Cognizant’s chargemaster services team is available to make changes directly in the CDM after a review, relieving the task from the administrative staff.

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{"0":"Ambulatory care organizations","1":"Hospitals and health systems"}

Clearinghouse services

Cognizant provides a comprehensive clearinghouse and RCM experience focused on innovation, stellar customer service and 40+ years of expertise. We use groundbreaking technology like AI and machine learning to improve claim outcomes. Our unparalleled customer support helps healthcare providers navigate intricate payment processes and collect revenue they are due.

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{"0":"Ambulatory care organizations","1":"Hospitals and health systems"}

Accounts receivable and denials management services

Cognizant employs a cross-functional approach, partnering with front-end and mid-revenue cycle teams to correct potential issues prior to claims submission. Collaboration with the patient access team helps track missing authorizations by payer to quantify possible retroactive authorizations. Working with the coding team can uncover inconsistent medical diagnosis codes, modifier issues and Current Procedural Terminology (CPT®) code errors. Cognizant’s technology allows our team to streamline denials into one platform and use data extracted from our clients’ 835s and 837s to map and categorize denials.

Learn more about AR recovery and denials services

Learn more about denials management technology solution

{"0":"Hospitals and health systems","1":"Ambulatory care organizations"}

Credentialing services

Streamline the credentialing process and prevent lags in payment due to unearned or expired credentials. Utilize our intuitive Pulse portal coupled with expert-supported end-to-end service for your organization’s credentialing needs. Our guided workflow can help you gain compliance quickly, saving you time and allowing you to earn reimbursements for your services as soon as possible.

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{"0":"Ambulatory care organizations","1":"Hospitals and health systems"}

Contract management solution

Cognizant’s contract compliance solutions measure the payment accuracy of payer-negotiated contracts, making it easy to identify underpaid professional and institutional claims, monitor medical billing rework and evaluate the cost of doing business with a payer. Our solution allows you to audit underpayments against contracted amounts, automate dispute documentation and track recovery efforts. The solution provides an analysis of the economic impact of fee schedule, pricing and edit adjustments, which help providers gain a competitive advantage during payer contract negotiations.

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{"0":"Ambulatory care organizations","1":"Hospitals and health systems"}

Patient communications and payments solution

This solution provides patients with customized payment options, patient-initiated payment plans and a simplified, easy-to-use platform that dynamically shifts the overall framework of patient collections. Patients experience a painless onboarding process, such as storing payment details for future payments, and can opt in for text message and email statements.

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{"0":"Hospitals and health systems","1":"Ambulatory care organizations"}

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How we transform organizations like yours

Mitigating denials, improving financial outcomes
Proper insurance verification for reduced write-offs
Increased upfront patient collections
Improve call center operations

The challenge

MetroHealth, a large, safety-net healthcare system, needed to mitigate a spike in payer claims denials to shorten outstanding accounts receivable days and increase cash collections.

Our approach

We deployed the Cognizant® Revenue Cycle Management Workflow solution and the Cognizant® Advanced Reimbursement Manager (ARM) Pro denials management solutions. This combination continuously deployed automation to improve process quality and financial outcomes while automating the previous manual process of identifying the root cause of initial claim denials.

Business outcomes

30% decrease in denials
$13M increase in revenue
25% increase in average daily collections

Read the full case study

The challenge

Anesthesia Financial Solutions required an insurance verification coverage strategy to lower the number of denials due to missed filing deadlines and prevent future write-offs.

Our approach

Cognizant’s TriZetto Eligibility solution was introduced and provided immediate gains in operational efficiency, reliability of data validation and increased payer remittance. The solution became the cornerstone of the revenue cycle process and is used as the foundation for all patient and staff validations.

Business outcomes

47% reduction in timely filing denials
44% reduction in overall write-off between 2022 and 2023
11% reduction in eligibility and registration denials
98% reduction in coordination of benefit (COB) inquiries

See the case study video

The challenge

Our client’s staffing levels were unable to support a company initiative to improve front-end patient access focusing on upfront payments and prior authorization.

Our approach

Cognizant provided knowledgeable and well-trained staff who easily stepped into revenue cycle management roles for the mental health and anticoagulation service lines.

Cognizant ensured patient liability estimates were calculated accurately within a short ramp-up period and delivered timely prior authorization filing and review.

The health system was able to consolidate its preservice patient access functions into one centralized team.

Business outcomes

49% increase in upfront collections in the first six months
304% increase in upfront collections in the first year

Read the full case study

The challenge

Client needed to implement a strategic and sustainable operations solution to support business changes and increased call center volumes.

Our approach

Collected and analyzed data to identify opportunities and prioritize actions
Identified technology solutions, streamlined workflows and determined additional staffing needs
Onboarded a new employee using change management tactics, which improved training, documentation and morale

Business outcomes

100% increase in call volume with minimal staff expansion
4.49/5 customer satisfaction levels
4.25% lower than industry-standard call center abandonment rate

Read the full case study

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Case studies

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LATEST THINKING

<h3>Thought leadership</h3>

Striking a balance: The role of medical coders in the age of automation

Kellye Reers explores how integrating autonomous coding with human expertise can enhance accuracy, efficiency and compliance in healthcare.

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Improving healthcare providers’ third-party liability claim strategy

What provider organizations need to know about third-party liability claims.

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Reducing payers’ clearinghouse risk in the age of cyber attacks

In an era where digital transformation is reshaping healthcare, robust cybersecurity measures are essential.

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Healthcare meets the market

Traditional market segments, consumer-centric healthcare models and vertical and horizontal integration are converging to provide seamless, high-quality healthcare experiences.

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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 healthcare solutions is vast and growing. Our expertise in healthcare IT services enables us to integrate cutting-edge technology seamlessly into your operations.

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

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