MODERN OPERATIONS FOR HEALTHCARE
Embrace AI-enabled healthcare operations
- Overview
- Outcomes
- Services
- Featured work
- Insights
- Explore BPS
- Contact us
$900M
cost savings over 7 years
17,000
hours of increased efficiency
75%
faster investigation response
25%
lower plan administration costs
600%
faster claims processing
Healthcare BPS and automation services
- Payers
- Digital revenue cycle management solutions
- Pharmacy benefit managers
- Horizontal offerings
Enrollment and member services
Our member enrollment, premium billing, reconciliation, and onboarding services put members at the center, ensuring a seamless experience across their multiple touch points. Our solutions in benefits configuration simplify complex structures and improve efficiency.
Provider data management (PDM)
Industry leading capabilities, from provider credentialing to contract loading and provider data management, our solutions ensure data accuracy. With Cognizant, payers can create comprehensive PDM strategies that focus on four components: single source of truth, data governance, bidirectional integration, and end-to-end platform. We help you structure your processes knowing that PDM is a journey, rather than a one-time initiative.
Claims administration
With deep understanding of claims processing—from front-end operations, claims adjudication and appeals to supporting Special Investigation Units (SIU). Our integrated solutions ensure accurate and timely payments, reducing interest payouts and penalties.
Clinical support services
Cognizant’s care management services can help payers gain access to certified and experienced talent pools globally. Our delivery teams offer expertise in utilization management, case management, and population health management—helping clients deliver improved clinical outcomes.
Customer experience management
Cognizant’s contact center services provide payers with digital transformation solutions that improve member and provider experience. Our services support members and providers with omni-channel contact services designed to improve customer satisfaction (CSAT) and NPS scores.
Full cycle RCM
Cognizant’s RCM gives an intuitive edge to the healthcare industry. From scheduling and registration to payment posting, we handle end-to-end revenue cycle management services for hospitals and physician practices. With proprietary RCM workflow technology, we help you maximize efficiency and improves cash flow with digitized management.
Front-end RCM
Our complete suite of patient access and engagement includes registration, scheduling, remote patient monitoring, discharge planning, health risk assessments, and wellness and lifestyle coaching. Improving these areas enables providers to embrace a digital-first, intuitive operating model—leading to fast, easy and safe experiences for their patients.
Middle office RCM
Cognizant provides customized coding and charge master services for any size or type of organization, from physician practices to hospitals. We leverage the latest RCM technologies to expedite and automate processes that help reduce errors and increase claim submission rates. Our fully outsourced mid-cycle RCM services will help you scale fast.
Back office RCM
Our account receivables service combines skilled professionals and proprietary technology to resolve accounts through all revenue streams. Established workflows, multi-channel outreach and financial assistance programs maximize revenue and recovery.
Complex claims
Cognizant can help healthcare organizations overcome growing reimbursement complexities and optimize revenue. With expertise and innovative technology, we identify the proper workers’ compensation and third-party liability carriers to ensure claims are paid in accordance with state regulations.
Clinical administration services
Our clinical administrative services focus on improving patient experience and quality of care. You’ll gain a competitive edge with our robust set of services—utilization management, bill review, record retrieval, gaps identification and physician training. Our resources include 350+ USRNs (registered nurses) and 700+ certified specialists.
Claims services
We offer a flexible pharmacy claims processing platform along with efficient distribution management services for employers and third-party administrators—enabling them to improve processes while controlling prescription costs.
Benefits configuration
Cognizant’s workflow extracts and consolidates information across all departments of the pharmacy benefit managers (PBM), providing plan sponsors with a 360° patient view that enhances critical health and financial decision-making resulting in best outcomes. We provide Day 1 assurance of correct adjudication outcomes, along with complete and accurate eligibility, prior authorization, accumulator and claim history data.
Frontend mailroom services
Cognizant enables modern operations by leveraging a data platform for order intake, a centralized workflow for prescription filling, a call center to support mail-order pharmacy services, and access to physicians’ offices to obtain prescription refills or to verify information.
Mail order processing
Our services include intuitive digital tools to analyze medication requests and calculate the urgency of the treatment—reducing errors and improving efficiency. To speed up order fulfillment, our workflow platform accounts for tracking, verification, approvals, follow-ups and on-time delivery.
Intelligent automation services
Get your business future-ready with industry-aligned IT and process automation solutions.
Cognizant Neuro® Business Processes
Simplify and accelerate automation adoption, integrate and orchestrate resources and see returns faster.
Business ops to accelerate scale
Grow digitally native scale-ups and new revenue streams at the speed of ideas.
Employee experience enterprise services
Find out how you can deliver persona-based employee experiences at scale.
Explore additional business process services
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 capabilities is vast and growing.
Let’s talk about how digital can work for your business.