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TriZetto Healthcare Products / Business Process-as-a-Service

Stop buying services and start buying outcomes

Rising administrative costs, outdated technology and limited internal resources are few of the challenges payers must conquer to succeed in today’s healthcare market.
Payers can address these challenges with the Cognizant® Healthcare Business Process-as-a-Service (BPaaS) solution. Leveraging a pre-integrated technology ecosystem with proven processes and experienced people, this integrated software and services solution applies a series of levers including process optimization, digitization and large-scale efficiencies—to help payers achieve new levels of operational efficiency and effectiveness.
Benefits to payers include:
    • Reduced costs
    • Increased scalability
    • Improved efficiency and quality
    • Enhanced compliance
    • Speed to Market

Features & functionality

The Cognizant Healthcare Business Process-as-a-Service (BPaaS) solution allows payers to focus on core business opportunities and free up capital to invest in innovation. Our integrated software and services solution combines automation, expert insight and best-in-class industry processes and platforms in an outcome-driven, integrated service delivery model.

Core transaction processing

Cognizant’s outcome-driven BPaaS delivery model supports payers in the medicare advantage, managed medicaid, medicare part D, duals, PDP, medicare dupplement, commercial, individual and small group markets with core transaction processing for:

  • Configuration
  • Enrollment/reconciliation
  • Fulfillment
  • Billing & financial reporting
  • Claims/providers
  • Encounters/RAPS
  • Provider & member call center
  • Mail Room and preprocessing services
  • Analytics, reporting
  • Appeals & grievances

Platform strategy over product strategy

Core IT modernization is achieved with access to the industry’s leading payer platform and ecosystem, which provides payers with a platform strategy rather than a product strategy. The high cost and stress of system changes and upgrades are eliminated by including maintenance and new releases within the Per Member, Per Month (PMPM) fee structure. With the Cognizant healthcare BPaaS solution, payers will always have current technology with built‑in scalability.

  • Rules-driven enrollment engine
  • Core platform
  • HIPAA gateway
  • Encounter Data Manager
  • Claims data manager
  • Financial reconciliation manager
  • Optum clinical editing
  • IVR & integrated CRM
  • Fulfillment tool
  • Imaging Application (web-based)

Increase revenue with better compliance

A top notch compliance program can do more than just help you avoid trouble; a properly administered compliance program can increase plan revenue by boosting star ratings, HEDIS scores and other measures of success, drive new business models and contribute to membership growth.

Cognizant’s healthcare BPaaS team includes an independent compliance and audit services department, governed by a compliance committee and chief compliance officer, dedicated to keeping you in front of regulatory and operational requirements. Services include:

  • Compliance oversight
  • Dedicated performance reporting (operations)
  • Dedicated audit function -  regulatory, delegation, state and CMS audit assistance
  • Security requirements
  • FWA & HIPAA compliance
  • Policies/procedures

Contact us

At Cognizant, we are here to provide you with more information about our TriZetto Healthcare Products software and service solutions and answer any questions you may have.

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