Our experience and capabilities will help you effectively address your Medicare administration needs, revenue management and data submission so you can respond quickly to evolving mandates and regulatory requirements.

The number of people receiving Medicare benefits is projected to rise nearly 60% by 2030. For health plans serving this market, long-term success demands increased system efficiencies to support this rapid growth. Medicare market success also requires tools that enable continued compliance with changes in Medicare reporting rules, complex Centers for Medicare and Medicaid Services (CMS) regulations and the Medical Loss Ratio (MLR) requirement.

With more than 30% of all Medicare Advantage and Part D lives processed on our core systems, the Cognizant line of TriZetto Healthcare Products provides an extensive portfolio of capabilities to meet the specific needs of your business. This comprehensive and highly effective combination of advanced technology and services offerings can help you lower administrative costs, increase speed to market and decrease total cost of ownership. Other capabilities work to:

• Automatically enroll new members
• Generate, edit and reconcile required Risk Adjustment Payment System (RAPS) and encounter data submissions
• Accurately reconcile Medicare members
• Enhance risk score accuracy to receive proper reimbursement
• Identify where members have Hierarchical Condition Categories (HCCs)
• Utilize analytics to improve your Five-Star Quality Rating
• Coordinate and improve care for Medicare members
• Manage new reimbursement and care models