Optimize experiences while lowering costs
Our end-to-end offerings help payer organizations thrive in the face of today’s complex regulations, elevated member demands and increasing cost pressures. Cognizant seamlessly connects payers and providers, helping to create frictionless member experiences and enabling more affordable care.
- Why Cognizant
- Services and products
- News
- Case studies
- Thought leadership
Increase payer efficiency, improve productivity, reduce costs and position your business for growth.
{"0":"All topics","1":"Commercial","2":"Individual and small group","3":"Duals","4":"Medicaid","5":"Medicare","6":"Specialty","7":"Third-party administration"}Designed to connect disparate systems and break down data silos to deliver secure, on-demand data access.
{"0":"All topics","1":"Commercial","2":"Individual and small group","3":"Duals","4":"Medicare","5":"Medicaid","6":"Third-party administration"}Deliver engaging experiences to members and providers, powered by data integration and real-time access.
{"0":"All topics","1":"Commercial","2":"Individual and small group","3":"Duals","4":"Medicare","5":"Medicaid","6":"Specialty","7":"Third-party administration"}Automate pricing scenarios to provide the best value to payers, providers and patients.
{"0":"All topics","1":"Commercial","2":"Individual and small group","3":"Duals","4":"Medicare","5":"Medicaid","6":"Third-party administration"}Enable payer-provider collaboration to reduce costs and drive overall quality improvement.
{"0":"All topics","1":"Commercial","2":"Individual and small group","3":"Duals","4":"Medicare","5":"Medicaid","6":"Third-party administration"}Extend the functionality of your core system by providing critical capabilities, from enrollment through encounter submissions to risk scores, so your business can efficiently administer government solutions.
{"0":"All topics","1":"Duals","2":"Medicare","3":"Medicaid"}Deliver engaging experiences to members and providers, powered by data integration and real-time access.
{"0":"All topics","1":"Commercial","2":"Individual and small group","3":"Duals","4":"Medicare","5":"Medicaid","6":"Third-party administration"}Connect care managers to members and providers while reducing costs, personalizing interventions and improving care quality.
{"0":"All topics","1":"Commercial","2":"Individual and small group","3":"Duals","4":"Medicare","5":"Medicaid","6":"Third-party administration"}TriZetto component solutions are designed to bridge the communication gap between payers and providers, facilitating seamless collaboration, reducing costs and improving care quality.
*HL7® and FHIR® are the registered trademarks of Health Level Seven International and their use of these trademarks does not constitute an endorsement by HL7.
{"0":"All topics","1":"Commercial","2":"Individual and small group","3":"Duals","4":"Medicare","5":"Medicaid","6":"Specialty","7":"Third-party administration"}TriZetto’s clearinghouse solutions enhance compliance and efficiency, improve member and provider experiences, and reduce costs.
{"0":"All topics","1":"Commercial","2":"Individual and small group","3":"Duals","4":"Medicare","5":"Medicaid"}Our healthcare BPaaS solutions feature integrated software and services, including process optimization, digitization and large-scale efficiencies.
Innovative partnerships are essential for payers, providers and pharmacy benefit managers to succeed in the competitive healthcare industry. We help clients rethink how they create value, innovate and grow by combining process expertise with intelligent digital platforms to optimize business operations.
In today’s dynamic healthcare environment, maintaining a skilled workforce can be challenging. Discover why organizations that embrace learning as a core competency are flourishing.
Rising costs, consumer demand, and changing regulations and guidelines are just a few of the market forces driving changes in the way healthcare organizations manage, optimize and transform their businesses. Our healthcare business consulting services use proven methods and strategies to help healthcare organizations transform and compete in this ever-changing environment.
Business demands keep changing, which means your infrastructure must do more to stay ahead of the curve. Cognizant cloud and infrastructure services ensure that your business is always ready, fuel employee productivity, integrate your departments and groups, and future-proof your organization.
Wherever you are on your journey—from aggregating data to building sophisticated AI models—Cognizant will meet you there. With our innovative offerings, you’ll be able to harness the power of data and AI to drive faster, predictive and proactive decision-making while educating your organization on the path forward.
Automate and simplify operational tasks associated with our core healthcare technology solutions, Facets and QNXT.
As competition encroaches on the traditional healthcare sector, Cognizant helps retail, specialty and mail order pharmacies and pharmacy benefit managers 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 end-to-end work enhances operations, increases efficiency, removes technical debt and modernizes applications for what is coming next.
PRESSROOM
How we transform organizations like yours
- BPaaS improves healthcare CX
- Health plan cuts key costs by more than 50%
- Powering business expansion with TriZetto QNXT
- No-disruption migration with robotic process automation
The challenge
Parkland Community Health Plan needed to meet the growing needs of its medically underserved populations. It sought to digitize its IT platform to better manage health data, member transactions and its provider network. The client wanted to transition from outsourced administration to remedy declining membership and gain better reporting.
Our approach
We introduced the TriZetto® QNXT™ core administration platform in a business process-as-a-service (BPaaS) model to include enrollment, claims, customer service and regulatory reporting modules, giving the client the flexibility and scalability needed to carry out its long-term growth plans.
Business outcomes
- Enhanced productivity
- Decreased core system costs
- Compliant transition in a virtual environment
The challenge
When our client won a bid to significantly expand its Medicaid membership, the plan was required to begin supporting more than 200,000 additional members. Claims volumes, member support needs and associated business processes needed to scale rapidly while continuing to meet stringent quality standards.
Our approach
The plan leveraged the native scalability of its core system, TriZetto® Facets®, to decrease customization, allowing it to put extra focus on improving annual upgrade patterns, renovating old code, improving batch job execution, and improving monitoring and alerting.
Business outcomes
- Reduced costs per member by nearly 54%
- Reduced costs per claim by more than 52%
- Reduced batch errors
The challenge
MedPartners was using an on-premises core system to provide administrative and claims processing services and outsourced its claims adjudication services to the core system’s vendor. As business grew, the core system couldn’t support the client’s business expansion plans.
Our approach
We implemented the TriZetto QNXT platform which has the automation and integration capabilities needed to automate critical manual processes and integrate key third-party systems and applications.
Business outcomes
- Saved $821,240 in annual labor costs
- Increased auto-adjudication to 75%
- Achieved 50% automation of referral program
- Increased operational efficiencies by 50%
- Redeployed 25% of staff to other key initiatives
The challenge
CareOregon needed to implement the TriZetto QNXT platform and migrate its behavioral health line of business to QNXT without disruption. Most of the plan’s behavioral health contracts were case rate value-based contracts that would be complex to translate to core functionality, and the client had to accurately import thousands of new providers and authorizations from its legacy system.
Our approach
We developed robotic processes to streamline the migration and ongoing processes. We quickly developed unique scripts, identified and prioritized the most critical processes, and aligned member and provider data—all leading to the development of nine robots for specific tasks and processes.
Business outcomes
- 162% return on each dollar invested
- 10,000+ hours saved monthly
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.