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To succeed, payers and providers need combined clinical, business and process expertise along with intelligent digital platforms to create efficient and agile operations. Cognizant provides business process transformation and managed services across the healthcare ecosystem. We leverage cloud, data, automation, AI and our industry leading Trizetto digital healthcare platform to develop and manage intelligent and adaptable operating models. This results in improved efficiencies, responsiveness and ability to unify the healthcare ecosystem.
reduction in operational costs in healthcare companies through business process transformation
With new digital operating models, healthcare companies can focus on enhanced consumer experiences and healing. Our services underpin the success of a new healthcare business model built on the features, functionality and value that consumers find indispensable.
Our deep relationships with leading healthcare organizations around the world put us in a unique position to deliver services through our integrated model, where we focus on the industry trends that are sustainable while investing in areas that drive fundamentally better outcomes at lower costs.
Evolve to meet the demands of constantly changing industry environments, shifting customer needs and the rapidly transforming technology landscape. This results in reduced costs, greater flexibility and growth generation.LEARN MORE
Modernize your claims submission process and provide real-time visibility into key metrics across your revenue management ecosystem. With our expertise, automation and analytics tools, we help your organization recoup lost revenues.LEARN MORE
Increase payer efficiency and growth, build strategic business agility, improve productivity, reduce costs and mitigate risks with our comprehensive BPaaS portfolio.LEARN MORE
Elevate workforce productivity by automating specific functions as well as end-to-end business operations. Leveraging leading automation platforms, we partner with you to improve workforce productivity and streamline customer experiences to drive business performance and growth.LEARN MORE
Transform finance and accounting operations into a value generator for your organization. Apply next-generation digital capabilities to enhance existing investments and turn procure-to-pay, order-to-cash, record-to-report and financial planning into valuable business insights.LEARN MORE
Achieve new revenue-generating opportunities for your organization with next-generation customer service. We enable you to deliver proactive, predictive interactions across all your customers’ preferred channels to deliver more efficient, effective and enriched experiences.LEARN MORE
A major U.S. healthcare organization with more than one million members in its government programs had difficulty modernizing the systems and capabilities required to comply with the emerging regulatory requirements of the Centers for Medicare and Medicaid Services. Its systems were outdated and expensive. Low automation rates, extensive manual processes and non-standardized data structures resulted in inadequate claims processing turnaround times and claims pricing inaccuracies. Antiquated customer service tools and minimal interactive voice response capabilities resulted in poor user experiences that hurt the brand and its standing with CMS.
The payer turned to Cognizant's healthcare technology experts for a comprehensive yet cost-effective solution that would solve its immediate need for a modern, end-to-end solution and provide a foundation for thriving under value-based care.
We deployed our Business Process-as-a-Service (BPaaS) solution for government programs, delivering a comprehensive TriZetto Facets core administration platform as a hosted service operated by Cognizant and overseen by the client. To begin with, Cognizant addressed the root causes of claims and encounter issues by collaborating with the payer’s senior operations executives and drawing on their extensive experience in government health plan administration. Facets enabled streamlined maintenance, standardized processes and improved system capabilities to reduce claims backlog. The solution also enhanced provider-matching rates by 3% to 4%, eliminating the chances of authorization rejection by plans due to invalid procedure codes.
A separate project introduced the Encounter Data Management module of Facets. It not only improved encounter utilization monitoring acceptance rates from 83% to 92% in just a month but also enabled the submission of more than $450 million in backlogged encounters, improving the payer’s revenue stream. Automating HIPAA authentication and self-service claims helped reduce call volume by 15% and call time by 30 seconds for remaining 51% of the call volume.
Cognizant helped the healthcare payer meet regulatory compliance levels and position itself for success under a value-based care model and emerging mandated interoperability requirements by improving processing speed and data accuracy. Integrating Facets features like NetworX Pricer helped the client achieve over 99% pricing accuracy through automation. We not only helped the payer enhance member and provider experiences but also boost its revenue.
reduction in plan administration TCO
reduction in call volume
claims pricing accuracy
The Everest Group identified Cognizant as the leader among the “2020 Healthcare Payer Operations—Services Market Star Performers”, based on the strongest forward movement demonstrated on the PEAK Matrix. Buyers have highlighted Cognizant’s key strengths to be digital capabilities and a collaborative approach to problem solving.READ MORE
Learn how Cognizant helps you unify the healthcare ecosystem, manage consolidation, and reduce administrative costs so you can focus on optimizing patient outcomes.LEARN MORE